Floridians should pay no more than is absolutely necessary for their medicines
It’s time to make our healthcare system work for us.
It’s time for the PBM Accountability Project of Florida.
WHO
WE ARE
The PBM Accountability Project of Florida is comprised of patient advocates, medical professionals, and other stakeholders working to help ensure that Floridians aren’t overpaying for prescription medicines they need. We are educating our fellow Floridians about the role Pharmacy Benefit Managers (PBMs) play in manipulating prescription drug prices and identifying solutions to return savings to patients, employee health plans, and taxpayers.
We are committed to finding meaningful reforms in the drug pricing system to minimize waste and ensure Florida patients, families, and communities can afford their medications.
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Together, we are:
providing resources to educate stakeholders
presenting effective, patient-oriented solutions
effecting change for the benefit of Florida patients, taxpayers, public and private sector purchasers of prescription medicines
PRESCRIBING
THE PROBLEM
Floridians face high out-of-pocket costs for healthcare. While breakthrough scientific research has changed how we treat – and even cure – health ailments and diseases, the true costs of these drugs and therapies are largely a mystery. Often, states that cover the cost of prescription drugs for state employees and Medicaid enrollees don’t know if they are paying a fair price, local pharmacies face high costs to distribute prescriptions to patients, and patients know very little about what goes on behind the pharmacy counter.
Pharmacy Benefit Managers (PBMs) are companies that manage the prescription drug benefit for public and private health insurers. Currently, just three PBM corporations control more than 80% of the U.S. market share, virtually eliminating a competitive environment. PBMs were meant to give patients and purchasers leverage when negotiating prescription medicine prices. However, these multi-billion-dollar corporations fail to pass a very large portion of those savings to the patients, employee health plans, and the public insurance programs that pay the final price.
In reality, a large portion of the negotiated savings never get to the patient; they go back to the PBM.
PBMs are not only keeping savings from patients, but also from pharmacists and state governments, ultimately forcing some local pharmacies out of business. The three PBMs controlling the market are all vertically integrated with major health insurers and affiliated pharmacies, such as CVS, to virtually eliminate competition for small, mom & pop pharmacies. At the same time, a growing number of states have found that they’ve been overcharged by PBMs to the tune of hundreds of millions of dollars.
SOLUTIONS FOR FLORIDA
PBMs are causing a serious strain on Floridians across the state, from senior citizens on a fixed income who cannot afford the exorbitant costs of their medications to family-owned pharmacies that simply cannot compete with the billion-dollar companies forcing them out of the market.
We’re working to identify ways to return prescription drug savings back to Floridians. Thankfully, Governor Ron DeSantis is working to rein in unchecked PBMs and state legislators are taking action.
Senate Bill 1550 and House Bill 1509 take steps to eliminate harmful clawbacks and spread pricing practices, prohibit PBMs from requiring consumers to use mail-in or PBM-owned pharmacies (known as “steering”), and require PBMs to identify certain affiliates that ultimately reduce competition in the marketplace.
These bills take critical steps to eliminate many of the games PBMs play, but more can be done to help Florida’s businesses, taxpayers, and ultimately patients at the pharmacy counter, including:
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Requiring PBMs to pass through prescription drug savings to Florida patients, businesses, and taxpayers;
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Instructing PBMs to report to Florida businesses and state government the PBM acquisition cost of medicines and the sources and amounts of all revenues PBMs receive; and
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Ensuring PBMs are paid only a transparent, competitive fee for the value of their services and do not profit from playing games with the cost of Floridians’ prescription medicines.
We support the Governor’s and legislators’ effort and hope to join the many other states that have successfully taken action to shine a light on PBMs’ opaque business practices:
Texas recently enacted sweeping legislation that protects community pharmacies and ensures patient choice by prohibiting PBMs from steering patients to pharmacies they own. It also improves patient access to needed prescription drugs while ensuring pharmacies are protected from PBM overreach.
Oklahoma signed into law legislation protecting both patients and pharmacies from PBM abuses by granting the insurance commissioner greater enforcement authority over PBMs, prohibiting the practice of spread pricing, and banning pharmacy network participation fees.
New Jersey has made significant changes to the way they work with PBMs. The state created a groundbreaking competitive marketplace for the contracting of prescription drug benefits. The online reverse auction model enabled the state to reduce its spending on prescription medicines by an unprecedented $2.5 billion over five years without imposing any pharmacy benefits cuts on public employees.
Minnesota’s reverse auction resulted in 27 percent savings for public sector budgets and taxpayers. As a result, the state is projected to save more than $28 million in drug costs for public sector employees in 2023 and 2024 alone.
Colorado hopes to save millions with the state’s reverse auction, once implemented.