Florida Governor Announces Pharmacy Benefit Manager (“PBM”) Legislation to Regulate PBMs
On Thursday, January 12, 2023, Governor Ron DeSantis announced a legislative proposal to regulate “unchecked” Pharmacy Benefit Managers (“PBMs”) operating in Florida. According to Governor DeSantis, the proposed legislation is designed to increase PBM transparency and accountability in the State. Governor DeSantis’s proposal has three main objectives related to PBMs and if enacted, would (1) protect patients from certain PBM mandated requirements, (2) protect community pharmacies from improper PBM business practices, and (3) rein in PBMs from conducting business in an unregulated manner. The proposed legislation would seek to achieve these outcomes in the following ways:
Enhanced Consumer and Patient Protections:
- Prohibit PBMs from mandating consumers to use a mail-order pharmacy but also allow consumers to opt-in to this service if preferred by the patient.
- Ensure no Florida-registered PBM mandates a narrow network that only includes PBM affiliated pharmacies.
- Preserve the ability for an in-person pharmacist-patient relationship within theircommunity.
Protections for Small Businesses including Independent, Community Pharmacies:
- Protect community pharmacies against surprise fees and clawbacks from PBMs, months after prescriptions are filled.
- Prohibit spread pricing where PBMs charge insurers and/or patients more for a prescription than it costs or more than they reimburse a pharmacy provider and then keep the difference.
Reasonable Regulation Requirements for PBMs:
- PBM registration requirements to be more comprehensive and aligned with other types of health benefit providers.
- Require PBMs to disclose all affiliated organizations, including affiliated pharmacies or companies within their corporate umbrella.
- Require PBMs to disclose complaints or settlements they have been a party before operating in Florida.
- Direct the Office of Insurance Regulation to take action against PBMs which violate state law and hold them accountable.
Governor DeSantis anticipates “broad support in the Florida Legislature” during the 2023 legislative session, which begins in March 2023. This is a positive development for patients and providers in Florida as Florida is a state that has lacked meaningful regulation of PBMs. If passed by Florida’s Legislature and enacted into law, PBMs will be limited in their ability to continue to engage in certain improper business tactics that have been significant issues for patients and providers over the past several years, including the improper exclusion of pharmacies from PBM networks.
How Frier Levitt Can Help
Frier Levitt represents numerous pharmacies across the United States in challenging PBM audits, network access, reimbursement practices and other complex issues including DIR fees. Our attorneys have extensive knowledge in all aspects of the pharmacy-PBM relationship. Contact us to speak with an attorney about how your pharmacy can leverage the various laws and protections afforded to pharmacies that regulate PBM conduct.