Independent pharmacies in Florida have reason to be optimistic about the future as it relates to Pharmacy Benefit Managers (PBMs) operating in Florida. This is because two pending bills, House Bill 357 (HB 357) and Senate Bill 742 (SB 742) would create much needed requirements for pharmacy PBMs to follow. HB 357 was unanimously approved in the House Health and Human Services Committee and will now be available for consideration by the entire Florida House of Representatives. SB 742 is still waiting to be heard by a Senate panel before the entire Senate will have an opportunity to vote on the bill.
HB 357 would enhance pharmacies’ rights as it relates to how PBMs conduct pharmacy audits. For example, if this proposed legislation were enacted, PBMs would be expressly required to notify a pharmacy at least seven calendar days before an initial onsite audit and limit the duration of the audit period to 24 months after the date a claim is submitted. In addition, HB 357 would provide pharmacies a right to appeal PBMs’ final audit findings.
HB 357’s Senate counterpart, SB 742, if enacted, would amend the Florida Pharmacy Act (the Act) to include a state Any Willing Pharmacy law. This is a significant legislative development. If enacted, any Florida pharmacy willing to accept reasonable terms and conditions established by a PBM must be admitted into the network. Further, SB 742 would amend the Act so that the entity enforcing the Act would shift from state health regulators to the Florida Office of Insurance Regulation (OIR), giving the OIR the express authority to suspend or revoke a PBM’s registration or impose a fine if it violates the law. For example, SB 742 expressly states that a PBM may be disciplined for excluding a pharmacy “that was willing to accept the plan’s terms and reimbursement, and that met the plan’s credentialing requirements and quality standards, from participating in the plan.” Finally, like HB 357, SB 742 amends the Act to allow a pharmacy to appeal a PBM’s final audit findings.
HB 357 and SB 742 are intended to regulate PBMs doing business in Florida in much needed ways as Florida is a state that has lacked meaningful regulation of PBMs. If passed by the Legislature and enacted into law, PBMs will be limited in their ability to continue to engage in certain improper tactics that have been significant issues for independent pharmacies 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. Our attorneys have extensive knowledge on all aspects of the pharmacy-PBM relationship. Contact us today to speak with an attorney about how your pharmacy can leverage the various laws and protections afforded to pharmacies, including Florida’s current PBM laws in addition to federal laws which regulate PBM conduct.
