Putting patients over profit in Florida
The prescription drug supply chain is extremely complex, and pharmacy benefit managers (PBMs) – intermediaries between health insurers and pharmacies, originally tasked with handling payment negotiations – don’t make it any simpler. Over time, the role of these multi-billion-dollar middlemen has become larger and increasingly more ambiguous, resulting in unchecked power and a dangerous level of influence that has allowed them to continue lining their executives’ pockets at the expense of patients.
But not anymore. With the Prescription Drug Reform Act (SB 1550), sponsored by State Sen. Jason Brodeur (R-Lake Mary) and State Rep. Linda Chaney (R-St. Petersburg), Florida took a long-overdue stand against mercenary PBMs – three of which currently corner over 80 percent of the market and rank among the Top 15 in the Fortune 500 – to put patients over profit.
During the 2023 Legislative Session, the Prescription Drug Reform Act, which is perhaps the most comprehensive PBM reform bill ever introduced in the nation, passed with overwhelming bipartisan support through all of its assigned committees and unanimously on both the floor of the Florida Senate and House of Representatives.
Then, within 24 hours after the bill passed both legislative chambers, Gov. Ron DeSantis signed it into law, touting it would “take the reins back” from PBMs. And naturally, coming from a seemingly fearless leader who regularly goes toe-to-toe with corporate giants and wins, he’s right.
When the Prescription Drug Reform Act goes into effect on July 1, 2023, patients will be protected from PBMs’ exploitation, and perhaps most importantly, they’ll be empowered to take control of their own health care decisions.
First, patients may notice immediate reductions in their out-of-pocket costs at the pharmacy counter. By implementing what’s referred to as “pass-through pricing,” PBMs will be expected to transfer prescription drug rebates directly to health insurers, with the sole intent of lowering premiums and copays, rather than keeping them, as has been the standard practice.
What’s more, PBMs will no longer be permitted to engage in “steering” – requiring or incentivizing patients to use their affiliated pharmacies – and they’ll also be prohibited from mandating the use of mail-order pharmacies. Patients will finally have the freedom to choose the pharmacy that’s most affordable or convenient for them, be it a mom-and-pop shop that’s been a cornerstone of their community for decades or the local Walgreens.
And that anti-steering provision, in particular, could be lifesaving for the sickest, most vulnerable patients.
A breast cancer patient can stay with the care team she knows and trusts for her chemotherapy treatment, instead of a PBM ordering her to an unfamiliar infusion center where the staff aren’t aware of her medical history and unique needs.
A heart transplant patient can get his anti-rejection drugs exactly when he needs them, instead of driving hours out of his way to a specialty pharmacy identified by a PBM that may or may not have his prescription filled when he gets there.
A young patient with a blood disorder can get the intravenous medication he needs to build back his strength and allow him to make it to his elementary school’s spelling bee, instead of sitting in a hospital bed for days because of the back-and-forth and red tape imposed by a PBM.
As a leader in Florida’s pharmacy industry who has repeatedly witnessed the blatant overreach of PBMs firsthand, I am both relieved and excited by the promise the Prescription Drug Reform Act holds for patients.
Our bold governor and legislators on both sides of the aisle are finally making it clear to PBMs: In Florida, patients come first.
Helen Sairany is Executive Vice President and CEO of the Florida Pharmacy Association and a member of EMPOWER Patients, a coalition comprised of patients and independent and community pharmacists and pharmacies focused on increasing access to affordable medication by drastically scaling back the role of pharmacy benefit managers (PBMs) in the prescription drug supply chain.
This article originally appeared on Fort Myers News-Press: Putting patients over profit in Florida
