BRANDON, Fla. — A bill introduced this week in the Florida House of Representatives would codify increased transparency regarding drug pricing and operating procedures of Pharmacy Benefit Managers, or PBMs, the people who operate prescription drug benefits for insurance providers and health care organizations.
- House Bill 961 authored by Rep. Jackie Toledo (R-District 60)
- Critics of current conditions say PBMs have little oversight
- More Capitol Connection stories
When Bob Patel became a pharmacist 20 years ago, he had no problem learning the ins and outs if the industry. For Patel, it was relatively simple: he filled a prescription and got reimbursed for it by the health care providers.
“Things were different years back,” he said.
But these days, running a family-owned pharmacy seems more like a chore than a labor of love.
“The biggest hurdle we have it that we don't have control over anything,” Patel said. ”They dictate the market. They steer their patients to their own pharmacies because most of those PBM chains own their big chains like big box pharmacies.”
Patel is referring to “pharmacy benefit managers” or PBMs. Critics claim because PBMs have little oversight, smaller pharmacies like the one Patel owns are hit with higher costs and lower reimbursement rates.
“Everyone is blaming the manufacturer of the drug, but really it's the PBMs that are artificially inflating the cost of the drugs,” said State Rep. Jackie Toledo (R-District 60). “The PBMs are the mafia of the legal drug world.”
To attack the problem, Toledo wrote and introduced House Bill 961, which calls for PBMs to be more transparent on pricing and operating procedures.
We reached out to the Pharmaceutical Care Management Association, a lobbying group that represents PBMs for a comment on this story. Calls were not returned.
Patel, meanwhile, is supporting Toledo's bill and hoping for change.
“We are just hoping for fair pricing and fair market share of whatever is out there,” he said.