TALLAHASSEE, Fla. - A new executive order is slated to help Floridians pay less for prescription drugs, adding more rules for the pharmacy and manufacturer middlemen known as pharmacy benefit managers.
Governor Ron DeSantis issued the new directive Friday to cut down markups passed on to consumers. State leaders said Floridians are overpaying and part of the reason includes pharmacy benefit managers or PBMs and some unfair practices they may do.
"Spread pricing is a deceptive practice where PBMs collect payment from the individual and keep leftover funds after they already reimbursed the pharmacy for the prescription and the service costs," said Governor Ron DeSantis, R-Florida.
The goal of a pharmacy benefit manager is getting the best price for consumers, but DeSantis said that doesn’t always happen. So the new executive order now forces them to be more transparent.
"We are directing our state agencies to look at all their contracts with PBMs and ensure that all costs to the state of Florida are justified," said DeSantis.
Healthcare advocates said the business model drove up prices, impacting doctors like Clearwater rheumatologist Robert Levin.
"As a rheumatologist, we’re stuck in the middle trying to get access for our patients to get the drugs they need to basically change their lives," said Levin, who is also president of the Alliance for Transparent and Affordable Prescriptions (ATAP). "[PBMs] impact which drugs can be prescribed and at what price, and the effect of them has been that they’ve actually caused major inflation in the list prices of drugs."
Levin said that generic drugs can be marked up along with specialty drugs. ATAP advocates for more transparency with PBM practices that allow kickbacks or rebates, causing consumers to be overcharged.
"The bottom line is that manufacturers have had to raise their prices so that they can pay more kickbacks so that they can get formulary access, and the patient is paying their co-payment on the full list price of the drug which as been pressured upwards by both the manufacturers but also by the PBMs," said Levin. "So all the generic drugs which have been subject to this spread pricing and have been grossly inflated will now that will cease, according to the executive order."
High prices moved billionaire investor Mark Cuban to open his own online pharmacy for low-cost generic drugs directly from the manufacturer. Others look outside the U.S. for medicine.
"I would also caution against going out of the country or engaging in a prescription drug tourism, specifically over the Internet," said Katherine Drabiak, an associate professor at the USF College of Public Health who specializes in health law, public health law and medical ethics. "There might be concerns relating to public health and safety, that consumers may think that they're getting a particular product, and they may not be getting that."
FOX 13 reached out to the Pharmaceutical Care Management Association, a group that represents pharmacy benefit managers. Spokesperson Greg Lopes released this statement:
"Pharmacy benefit managers have an established track record of using proven tools to generate significant savings for Florida’s Medicaid program and division of state group insurance. We look forward to working with Governor DeSantis’ administration in ensuring all Floridians have affordable access to their prescription drugs."
The goal is to help people like Dr. Levin's patients save on drugs they need.
"Potentially it could be in the hundreds to thousands of dollars per month, potentially depending on what they find and then what the state is going to do about it once they actually get the data," said Levin.
DeSantis said the state will now require audits from pharmacy benefit managers to help keep them accountable.
"They are entitled to get paid for their work. But it's saying make sure that that's a fair payment and an accurate representation of the work that they're doing and that they're not giving these kind of false rebates," said Drabiak, explaining the executive order’s impact to Floridians.
Healthcare advocates with Florida Voices for Health said the executive order is progress, but they also hope the state will look at lowering deductibles for all Floridians.