There’s an old saying that an ounce of prevention is worth a pound of cure. That’s just as true in law enforcement as it is in medicine – and it’s badly needed here in Florida.
Every year, prescription drug fraud committed by independent pharmacists costs patients, taxpayers and businesses billions of dollars in the form of higher prescription drug costs. This problem is serious, and lawmakers need to take real action to prevent and crack down on it.
Recently, a federal jury convicted Peter Bolos, the owner of Synergy Pharmacy in Palm Harbor, Florida of committing $174 million in prescription drug fraud. His specific crimes include conspiracy to commit health care fraud, 22 counts of mail fraud and felony misbranding of medication.
Bolos and his employees conspired to rig prescription purchases, deceived and stole insurance information from Florida patients and misled doctors into writing expensive and unneeded prescriptions. Millions of dollars were stolen from hardworking Floridians and funneled into these criminals’ pockets. This is a particularly despicable offense given that so many Floridians struggle to afford prescription drugs. And worse, several of the groups that Bolos defrauded work to help seniors and veteran families through public health programs like Medicare and Tricare.
Organizations called Pharmacy Benefit Managers (PBMs) can help stop this type of fraud – which is 700 percent more likely to occur at independent pharmacies than at chain or retail pharmacies. PBMs work to provide affordable, accessible prescription drugs to patients by negotiating with big drug companies on behalf of plan sponsors like employers, unions, and public health programs.
PBMs also serve as the first line of defense against prescription drug fraud by using state-of-the-art techniques when working with pharmacies to detect and report suspicious behavior. However, restrictions and regulations that state lawmakers have placed on PBMs make it harder to stop this criminal activity and keep costs down for patients.
Given the multi-million dollar price tag of Bolos’ crimes, and the significant taxpayer cost of investigating and trying his case, encouraging PBMs and empowering them in their pharmacy oversight role should be a no-brainer.
Yet, instead of supporting PBMs’ efforts to prevent this criminal activity, some Florida legislators have tried to attack them with burdensome regulations. Last session, multiple bills were introduced that would have undermined innovative cost-saving methods utilized by PBMs to lower drug costs for employers, consumers, and the health system. They also would have weakened PBMs ability to detect and stop pharmacy fraud.
Going into 2022, there is already pre-filed legislation like HB 357 and SB 742 that may again restrict PBMs in ways that will harm Floridians. Why are our legislators seeking to weaken PBMs that help to keep costs down for patients when our health care system is already working overtime heading into the third year of the COVID-19 pandemic?
Prescription drug fraud is a crime, and our legislators need to prioritize cracking down on these bad actors so that hard-earned taxpayer dollars aren’t further wasted. Bolos’ case is not unique, and it will happen again if we don’t take action. To help bring down the cost of prescription drugs, we need our lawmakers to stop targeting PBMs and let these organizations make prescription drugs more affordable – and stop costly criminal fraud.
Jim Maxwell is the vice-chairman of Floridians for Government Accountability
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