Guest Author
I would like to thank Senate President Kathleen Passidomo, House Speaker Paul Renner, Gov. Ron DeSantis, and the bill sponsors for passing historic legislation that will increase Pharmacy Benefit Manager (PBM) transparency and will make access to lifesaving drugs more accessible to thousands of Floridians.
I, like many Floridians, believe that PBM business practices have made it unnecessarily difficult for independent pharmacies to thrive and for residents in rural areas to obtain necessary prescription drugs.
Although PBMs have recently become prominent in the health care industry, serving as intermediaries between drug manufacturers, pharmacies, and health insurance companies, their role has been increasingly scrutinized due to their adverse effects on patients and the health care system, especially in Florida. Due to their reimbursement practices, these “middlemen” make it especially difficult for smaller, independent pharmacies to compete and, in turn, affect Floridians every day.
Anyone who has encountered PBMs knows their business practices have become increasingly complex. They are in essence, third-party administrators who over the course of a few decades have grown into a multibillion-dollar industry, in some cases, dwarfing both the manufacturers and health plans they serve. Initially, they were intended to lower prescription drug costs and advocate for patient benefits. However, their business practices, including rebate schemes that increase costs, formulary lists, and the near monopoly they have on the market, have made it so that the annual cost of prescription drugs increased.
The legislation recently signed into law will take away the spread pricing model used by PBMs to charge insurance companies a high price for prescription drugs without reimbursing the pharmacy the full amount, pocketing the difference at the expense of independent pharmacies. PBMs also enforce gag clauses, preventing pharmacies from informing patients of cheaper alternatives for lifesaving medication.
This legislation will increase transparency in the pricing process by requiring PBMs to disclose how they set drug prices, how much they receive in rebates from drug manufacturers, and how much they reimburse pharmacies. This will prevent PBMs from charging inflated prices as “middlemen” and pocketing the difference, thus lowering costs for Floridians and supporting independent pharmacies.
Importantly, PBMs will no longer be able to require patients to use certain pharmacies to get their medications. This will allow Floridians more choices, especially in rural areas where some PBM-required pharmacies could be miles away.
This legislation will make a massive impact by reining in PBMs and improving the system for everyday Floridians.
Thank you again, to President Passidomo, Speaker Renner, and Gov. DeSantis for supporting SB 1550, paving the path toward a more equitable health care system, standing up for Florida’s small businesses and making the lives of Floridians and independent pharmacy owners easier.
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Rep. Ralph Massullo, M.D., represents HD 23 in the Florida House.
