Florida PBM reform bill amended to remove popular provisions

Mansur Shaheen | Apr 7, 2021 | Florida

Significant changes were made this week to a bill in Florida that would regulate Pharmacy Benefit Managers (PBMs) in the state. Advocates for PBM reform are unhappy with the changes, believing that the bill waters down any sort of regulations.

House Bill 1155 was filed by Rep. Jackie Toledo on February 19. The initial bill would have allowed the state to audit PBM’s and prohibited “clawbacks”, a process where PBMs can retroactively reduce reimbursements paid out to pharmacies. The Office of Insurance Regulation would also have access to records, data and information collected by PBMs as to what drugs they were distributing and at what prices. Those provisions have instead been removed from the bill by a house panel in an amendment.

 

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The current version of the bill would enforce a $10,000 penalty to PBMs who operate in Florida but do not register in the state. Rep. Mike Caruso referred to the penalty as a “joke”, as the profits PBMs generate through actions that would go unregulated are often much more than $10,000.

David Poole, the director of legislative affairs at the AIDS Health Care Foundation said in his testimony opposing the move:

“In analyzing the changes to the original bill we had to ask ourselves if ‘some’ PBM reform is better than ‘no’ PBM reform.  Consequently, we concluded that some is better than none. However, we think this bill falls way short of the needed reforms.”

Small Business Pharmacies Aligned for Reform, a special interest group that advocates for PBM reform, opposed the changes to the bill as well. 

Regulations for PBMs have become a national talking point after a Supreme Court case last year opened the door for them. Rutledge vs. PCMA, an Arkansas case filed after the state legislature attempted to regulate PBMs, was ruled in favor of the state. The court ruled the regulations on PBMs did not break the Employee Retirement Income Security Act of 1974 (ERISA). Now that the precedent is set, state’s can pass PBM legislation without fear of being struck down by the courts.