Earlier this year, Gov. Ron DeSantis announced plans to address the role pharmacy benefit managers (PBMs) play in the high costs so many of us are paying for prescription drugs.
Floridians don’t need academic research or statistical studies to tell us that we’re paying more than we should for the medications we need. We feel it at the pharmacy counter on a regular basis and that’s why the governor’s push, and the state Legislature’s action, is so important.
It would be difficult to find a Floridian who doesn’t have a story to tell about how high out-of-pocket prescription drug costs have affected them. I’m among them after having been told by my local pharmacist that a one-month supply of a prescribed medication would cost me $5,000 out of pocket, only to be told by my insurance company that I could reduce that cost to $25 by ordering a two-month supply. We are receiving our medicines within a system that seemingly has little rhyme or reason to it, but that can put seniors with serious health conditions and who may be on a fixed income in terrible positions.
The corporate middlemen known as PBMs are largely responsible for this. Health insurance companies, as well as state governments for their Medicaid programs, pay PBMs to negotiate prescription savings with the pharmaceutical manufacturers. The PBMs, in turn, reimburse pharmacies for the medicines that are dispensed to patients. If the system works as intended, both consumers and taxpayers save money on prescription medications.
But that’s not what’s happening. We know through personal experience that our costs aren’t going down. The drug prescribing industry has consolidated to the point that just three companies control 80 percent of the market, and they’re using that economic clout to (1) negotiate savings from drug companies, but keep them rather than pass them along to patients, (2) pay pharmacies far less than the payments they receive from their health plan and state government clients, profiting handsomely from this “spread,” and (3) limit patient access to prescribed medicines by selectively allowing insurance coverage for drugs that generate greater profits.
In fact, last year, the PBMs made it so more than 1,000 medications were not covered by insurance, essentially placing themselves between patients and the doctors who decide what treatments are most effective. In 2021, PBMs charged Florida Medicaid nearly $4,900 per prescription for a common cancer medication that costs approximately $90. This system is no longer working for those of us who need prescription medications to maintain our health.
DeSantis was appropriately direct when he addressed this issue with state lawmakers at the start of this year’s session.
“Floridians are also harmed by inflation when it comes to the prices of prescription drugs, especially due to pharmacy middlemen. We must bring transparency to the system so that Floridians can save money on their drugs. We need reform of the PBMs,” DeSantis said.
My organization, Seniors Across America, couldn’t agree more. This is why Seniors Across America, along with the Florida Medical Association, Florida Osteopathic Medical Association and the Christian Family Coalition created the PBM Accountability Project of Florida. And it’s why we support legislative efforts underway to enact PBM reforms.
We all want the same thing, to rein in the unchecked PBMs that have avoided accountability for too long and to eliminate their harmful drug pricing practices.
The proposals before the Florida legislature will eliminate many of the anti-consumer games PBMs play. As bills make their way through the legislative process, I encourage lawmakers to build on this momentum to hold PBMs accountable.
Florida is now in a great position to help seniors afford their medications. If these bills pass, PBMs will be compelled to operate in a manner more favorable to patients and we will receive a lifeline in the form of lower prescription drug costs. No one should have to go to the pharmacy and be hit with outrageous charges for medicines they need.
John Grant is a former Florida state senator. He is the president of Seniors Across America and a member of the PBM Accountability Project of Florida.
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