Florida Law Puts Drug Pricing by Pharmacy Benefit Managers Under a Microscope Once Again

He sees recent actions more as a step in the right direction than any sort of sea change, adding that it’s no time to slack off advocating for patients in Florida and elsewhere. He hopes Gov. DeSantis will do more with PBM reform if he is reelected.

“There is a danger of people feeling like our work in Florida is done on the PBM issue,” says Mr. Cantrell. 

Dr. Solow

Elizabeth “Blair” Solow, MD, assistant professor of medicine in the Division of Rheumatic Diseases at UT Southwestern Medical Center, Dallas, and chair of the ACR’s Government Affairs Committee, agrees and notes the Florida executive order has limitations. For example, it covers only state agency contracts, such as Medicaid and the state employee benefit plan. This means the order impacts only a portion of Florida’s population and “can easily be undone” by a new administration, she says.

“It is imperative that Florida enact legislation to codify these protections and expand them to all Floridians,” Dr. Solow says.

At the national level, the Federal Trade Commission (FTC) is seeking records from six of the biggest players in the industry as part of an investigation into PBM practices.

“Although many people have never heard of pharmacy benefit managers, these powerful middlemen have enormous influence over the U.S. prescription drug system,” FTC Chair Lina M. Khan said in a June 7 release. “This study will shine a light on these companies’ practices and their impact on pharmacies, payers, doctors and patients.”⁶

The probe will examine how vertically integrated PBMs affect access and affordability of prescription drugs, according to the release. Also on June 7, the ACR issued a statement in support of the FTC action.

“The FTC investigation announced today is a critical step toward greater transparency and oversight over PBMs’ opaque business practices, as well as the enactment of meaningful drug pricing reforms that will reduce costs and expand access to important therapies for our patients,” states the ACR release.⁷

Catherine Kolonko is a medical writer based in Oregon.

References

1. HB 357—Pharmacies and pharmacy benefit managers. My Florida House.gov. Effective date: 2022 Jul 1. https://www.myfloridahouse.gov/Sections/Bills/billsdetail.aspx?BillId=73589&SessionId=93.
2. House of Representatives staff final bill analysis: Bill HB 357—Pharmacies and pharmacy benefit managers. 2022 Jun 21. https://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?FileName=h0357z1.FFS.DOCX&DocumentType=Analysis&BillNumber=0357&Session=2022.
3. Pharmacy benefit managers. National Association of Insurance Commissioners. Last updated 2022 Apr 11. https://content.naic.org/cipr-topics/pharmacy-benefit-managers#:~:text=Today%2C%20there%20are%2066%20PBM,of%20UnitedHealth%20Group%20Insurance)%20%E2%80%93%20controlling.
4. Governor Ron DeSantis takes additional actions to lower prescription drug prices for Floridians. News release. 2022 Jul 8. https://flgov.com/2022/07/08/governor-ron-desantis-takes-additional-actions-to-lower-prescription-drug-prices-for-floridians.
5. Lupkin S. Patients overpay for prescriptions 23% of the time, analysis shows. Kaiser Health News. 2018 Mar 13. https://khn.org/news/paying-cash-for-prescriptions-could-save-you-money-23-of-the-time-analysis-shows.
6. FTC launches inquiry into prescription drug middlemen industry. Federal Trade Commission. 2022 Jun 7. https://www.ftc.gov/news-events/news/press-releases/2022/06/ftc-launches-inquiry-prescription-drug-middlemen-industry.
7. ACR applauds FTC decision to investigate PBM business practices. Press release. 2022 Jun 7. https://www.rheumatology.org/About-Us/Newsroom/Press-Releases/IDs/1218.