Pharmacists would be required to advise people about the costs of prescriptions and whether the retail prices of drugs are lower than cost-sharing requirements imposed by insurers or HMOs, under a bill approved unanimously Wednesday by a House health-care panel.
Filed by Rep. David Santiago, R-Deltona, the bill (HB 351) also would require pharmacy benefit managers — often called “PBMs” — to register with the Florida Office of Insurance Regulation and to supply information about their chief executive officers, chief financial officers and people responsible for the day-to-day operations of the companies. Registrations would be valid for two years.
Santiago said the bill, approved by the House Health Innovation Subcommittee, “begins to shine light and accountability” on pharmacy benefit managers and their practices.
Insurers and HMOs use pharmacy benefit managers as intermediaries with other health-care companies. Among the largest are Express Scripts and CVS Caremark. Pharmacy benefit managers negotiate large customer contracts and negotiate with pharmacies and pharmaceutical companies to get the best rates.
In addition to requiring pharmacy benefit managers to register with the state, the bill would amend insurance and HMO laws to detail what is allowable in contracts with pharmacy benefit managers and what is banned.
For instance, under the contracts, pharmacy benefit managers could not limit the ability of pharmacies to substitute generic equivalent drugs for brand-name drugs.
Rep. Nicholas Duran, D-Miami, said he was concerned the bill only ties the prohibition to contracts and that Santiago should consider changing it to make sure other documents between insurers or HMOs and pharmacy benefit managers would not impede pharmacists’ ability to let patients know about the most cost-effective options.
The bill is next scheduled to head to the House Appropriations Committee.
While the bill was supported by pharmacists and physicians, Abigail Stoddard, a lobbyist for Prime Therapeutics, raised some concerns. Those concerns included amending state insurance and HMO laws with measures that are currently included in pharmacy regulations. Prime Therapeutics is a pharmacy benefits management company owned by 18 Blue Cross and Blue Shield health plans.
The House Health Innovation Subcommittee also approved a pharmacy-related bill that would preclude HMOs and insurers from requiring customers to be subjected to repeated “step therapy” protocols.
As initially filed, the proposal (HB 199) would have required insurers and HMOs to authorize or deny physicians’ requests to circumvent “step therapy” requirements within three business days for non-urgent care situations and within 24 hours for urgent care situations. If the requests were denied, insurers would have been required to provide detailed written explanations of the denial.
Step therapy is a type of prior authorization where patients must first try less-expensive drugs before they can “step” to more expensive drugs.
Bill sponsor Shawn Harrison, R-Tampa, says the initial bill was identical to a Senate measure (SB 98), which he prefers. But Harrison says he agreed to changes as a way to get the issue considered in the House.
“This is a vehicle we thought we could get started with,” Harrison says. “It’s smaller and we’ll see how it goes as the process moves along.”