Florida Pharmacists Support Legislation to Reform PBM Practices

Published Online: Wednesday, March 26, 2014
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Alexandria, Va. Mar. 26, 2014 - Pharmacists strongly support two proposed bills that would take reasonable steps to protect small business community pharmacists in Florida as well as the patients they serve, the National Community Pharmacists Association (NCPA) said today.

SB1014 would provide for a reasonable degree of transparency into reimbursement for the cost of generic drugs. SB702 would allow legitimate oversight of pharmacies to continue while reining in abusive audit practices that harm patient care, small business community pharmacies and state revenue. These bills would collectively provide common sense small business safeguards while resulting in no cost increase to the system, despite misleading claims.

Billion-dollar pharmaceutical middlemen known as "pharmacy benefit managers" (PBMs) have generated a profitable revenue stream by taking advantage of their authority to both dictate reimbursement for generic drugs and also to review and overturn prescription claims from local pharmacies after prescriptions have been filled and prescription drugs provided to patients.

Community pharmacies are often forced to pay thousands of dollars as the result of an audit for nothing more than basic clerical or typographical mistakes, many of which are not the fault of the pharmacist or pharmacy staff. Bipartisan legislation similar to SB702 has been enacted in 29 other states, with additional state legislation only waiting on the governor's signature. These bills and enacted laws provide for reasonable standards for pharmacy audits while allowing them to continue for their intended purpose of penalizing true fraud and abuse.

Moreover, PBMs are lax in raising generic drug reimbursement rates even though pharmacy costs of acquiring many generic drugs have been skyrocketing due a wide variety of factors over the past couple of years. Thus PBMs pay pharmacies at outdated, lower prices while charging health plans at a higher rate. When generic drug reimbursement rates finally are raised to reflect market costs, it is rarely done retroactively.

PBMs claim that transparency will increase costs they charge, while in reality they only fear the light that will be shed on the millions of dollars they are pocketing through current practices. Recently national media outlets such as USA Today and Fortune have examined the shadowy world of PBMs and raised significant questions about PBM business practices, in articles entitled "Do drug benefit managers reduce health costs?" and "Painful prescription," respectively. In addition, federal Medicare officials have admonished PBMs specifically over audit abuses of pharmacies in Medicare drug plans.

"When pharmacists dispense the right medication to the right patient at the right time and for the agreed-upon reimbursement, it should not be a punishable offense," said NCPA CEO B. Douglas Hoey, RPh, MBA. "Unfortunately, too often pharmacists are plagued both by egregious audits focused on hyper-technical clerical issues as well as losses of $60, $100 or more per prescription due to outdated reimbursement rates. Not only do these PBM practices undermine patient care, but they also siphon dollars away from local communities and send them out-of-state to Fortune 500 pharmaceutical middlemen."

"NCPA is proud to support the work of the state's lawmakers and a host of pharmacy organizations including the Florida Pharmacy Association, PPSC, FIPN, FSHP, IPC, EPIC, APCI and Walgreens and all Florida pharmacists in this effort," Hoey added.

Upon introduction of SB 702, the bill's author State Sen. Aaron Bean (R-Jacksonville) said, "With SB 702, there can be clear guidelines of acceptable audit practices of our pharmacies. I am hopeful these guidelines will result in better health care for all Floridians."
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