| Pharmacy Benefit Managers Info Series Part Five Thanks for following along with our five-part email series on Pharmacy Benefit Managers. After providing information about PBM’s from a few different perspectives, we’re now ready to focus on what many others in the know have been discussing in-depth, namely, reform. This is the part where you can become involved if you feel so compelled, so let’s get to it! PBM’s: What we’re doing to fight back, and ways you can help. Fortunately, legislators have been digging into the history of PBMs for a few years, and in 2021 The Pharmacy Benefit Manager Transparency Act of 2022 was introduced with thorough bipartisan support. It was approved by the Judiciary Committee and “prohibits a number of the types of activities that have been described, including spread pricing and payment clawbacks from pharmacies.” In early 2022, the FTC also voted to begin an investigation into PBM business practices, “focusing on fees and clawbacks to pharmacies, the impact of rebates, complicated methods to determine pharmacy reimbursement, and others.” Both these things are big deals federally, but we also need to look at things on the state level, especially in Florida, where healthcare is HUGE. To date, more than 45 states have passed laws regulating PBMs, all to varying degrees. Since many PBMs and their related pharmacies operate in all states, they need to incur extra legal work to ensure that their operations and contracts are structured to comply with state PBM regulatory requirements. Florida is a state leading the charge in finding innovative ways to drive transparency and accountability among healthcare services, but there’s still work to be done. On January 12th, 2023 Governor Ron DeSantis unveiled a legislative proposal to “reign in unchecked PBM’s and drive transparency among prescription drug prices influenced by Big Pharma.” The proposal takes the following steps for accountability: Requires PBMs to disclose all organizations affiliated with the applicant, including any affiliated pharmacies or companies within their corporate umbrella.Requires PBMs to disclose any complaints or settlement agreements they’ve been party to prior to operating in Florida.Directs the Office of Insurance Regulation to take action against PBMs which violate state law and hold them accountable, as is consistent with all insurers.Join the fight! Florida’s 2023 State Legislative Session begins on March 7th. That means there is still time for you to reach out to your state house member and senator and urge them to support this important proposal. Looking to take even more-direct action? Then reply to Justin Bouck with FGS if you want to be considered to get involved in Tallahassee this legislative session. Florida has an incredible opportunity to make a difference this year and reign in the PBM gatekeepers on our home turf, which could set the stage for other regulations in other states and at the federal level. |
