Florida Senate Introduces PBM Regulation Bill as Promised by Governor DeSantis

On Friday, March 3, 2023, the Florida Senate introduced Senate Bill 1550 (“SB 1550”) which would regulate Pharmacy Benefit Managers (“PBMs”) operating in Florida. In January 2023 Governor DeSantis announced proposed legislation designed to increase PBM transparency and accountability in Florida and indicated that the legislation would be coming in March 2023. The Florida Senate delivered on Governor DeSantis’s promise by introducing SB 1550 which reflects the Governor’s proposal and includes additional detail. Among the provisions of SB 1550 are three main objectives related to regulating PBMs. If enacted, SB 1550 would provide:

(1) enhanced protections for consumers and patients,

(2) protections for small business including independent, community pharmacies, and

(3) reasonable PBM regulations.

More Specifically, SB 1550 would address concerns arising from PBM conduct in Florida in the following ways:

Enhanced Protections for Consumers and Patients

  • Prohibit PBMs from mandating consumers to use a mail-order pharmacy but allow consumers to opt-in to this service if, and only if, preferred by the patient.
  • Prohibit PBMs from establishing mandatory networks comprised exclusively of PBM affiliated pharmacies.

Protections for Small Businesses including Independent Community Pharmacies

  • Prohibit PBMs from instituting a network that requires a pharmacy to meet more stringent standards than is required by state law and federal law.
  • Protect community pharmacies against surprise fees and clawbacks including direct or indirect renumeration fees (“DIR fees”) often assessed by PBMs.
  • Prohibit spread pricing.

Licensing and Registration Requirements for PBMs with Oversight by Office of Insurance

  • PBMs required to obtain certificates of authority to conduct business in Florida by January 1, 2024.
  • To receive a certificate of authority, PBMs must disclose all affiliated organizations, including affiliated pharmacies.
  • Disclose all complaints, settlements, or discipline they have been a party to in any state.
  • Direct the Office of Insurance Regulation to discipline PBMs which violate state law and hold them accountable.

Governor DeSantis has been vocal about the need for reasonable regulation of PBMs, and the Florida Legislature has echoed its support by introducing SB 1550. SB 1550 would be a positive development for patients and providers in Florida. SB 1550 has the potential to limit PBMs’ ability to engage in certain improper business practices that have been significant issues for patients and providers in Florida, 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 such as 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 applicable laws and protections afforded to pharmacies that regulate PBM conduct.