Florida is fortunate to be home to one of the strongest, most active senior communities in the nation. The state attracts older adults who want to enjoy their retirement years with purpose — spending time with family, volunteering in their communities, supporting local businesses, and pursuing healthy, independent lives. I hear from seniors every day who credit modern medicine, strong relationships with their doctors, and stable access to treatments for helping them stay active and engaged.
That’s why it’s so important that Florida carefully evaluates any proposal that affects the medicines seniors rely on. Lowering costs is a goal we all share, but how we lower costs matters just as much as the outcome. And right now, there is a provision in House Bill 697 that could unintentionally put Florida seniors at risk of losing access to the very treatments that keep them healthy.
The proposal would tie Florida’s drug reimbursement to prices set by foreign governments, a concept often called “Most Favored Nation” (MFN) or international reference pricing. On the surface, it may sound like a simple way to reduce costs. But the systems Florida would be mirroring come with serious access limitations that disproportionately affect older adults and people with chronic or disabling conditions. Those risks deserve attention.
Many of the countries used in MFN models rely on a metric known as the Quality-Adjusted Life Year, or QALY. While the term is technical, the effect is straightforward: the QALY assigns lower value to treatments for seniors, people with disabilities, and those living with long-term illnesses. That’s why federal law prohibits Medicare from using QALYs in coverage decisions, because seniors should never be told their lives are worth less on a spreadsheet.
The concern for Florida is not that state lawmakers intend to adopt QALYs. They do not. The concern is that tying Florida’s reimbursement to foreign government price lists implicitly imports the access restrictions those systems produce, restrictions that often stem from QALY-based decisions abroad. Seniors may not see the term written into law, but they could feel the effects if essential medications become harder to access because reimbursement no longer aligns with real-world needs.
That’s not the outcome Florida wants. And the good news is, there are other alternatives to achieve our shared goal of lower costs.
Seniors deserve a system that reflects their dignity, values their years of contribution, and protects the choices they make in partnership with their physicians. We can move toward affordability without adopting foreign pricing structures that limit access or delay treatment. For example, Florida’s policymakers can require that the billions in discounts and rebates PBMs and health plans receive from manufacturers are passed directly to Floridians at the pharmacy counter, instead of being kept as profit. Policymakers can also work to ensure that copay assistance actually counts toward deductibles and out-of-pocket limits, which would make an immediate, meaningful difference for seniors on fixed incomes. They can also modernize how PBMs are paid so that compensation is a fixed fee, not tied to a list price of a medication. These are practical reforms with real-world results.
I am confident that Florida’s leaders, who have consistently stood up for older adults, will take the time to ensure any reform truly reflects the needs of the people it aims to help. And we can do it the Florida way, with solutions that honor our seniors and strengthen the care they count on every day.
Conwell Hooper is Co-Founder and Executive Director of the American Senior Alliance.
