Florida seeks to limit power of pharmacy benefit managers

THE VILLAGES, Fla. - Many people who use prescription drugs have never heard of pharmacy benefit managers, or PBM's. But if you take prescription meds, they're the ones who usually control which ones you have access to.

"It's most of the business, it really is. Almost every single claim or every single prescription you dispense has to go through a PBM," said Dr. Anthony Maldonado, a Sanford pharmacist.

Maldonado says it's often the case a patient needs a certain kind of medicine, but he can't provide it because it's not on the PBM's list of approved drugs, which is called a formulary. 

"There are circumstances where a physician prescribes a medication for a patient and it's not on the formulary. So there is a process which tends to delay for that patient to get therapy, and again it's not on the formulary. The PBM's determine what's in and what's not," he said.

At an announcement this morning in the villages, Florida Gov. Ron DeSantis announced that the state aims to limit the PBM's power to set which drugs patients can access.

 "Probably the most significant thing that we're doing in this proposed legislation is reining in these unchecked pharmacy benefit managers, PBM's," he said.

The state's plan includes prohibiting PBM's from mandating mail-order pharmacies for patients, ensures that no Florida-based PBM mandates a narrow network of affiliated pharmacies, and preserves patients' ability to use their own community pharmacist. It would also require PBM's to publicly disclose the pharmacies and insurers they work with, along with any complaints or settlement agreements they've been involved in.

The governor's office says they would work with the legislature on these proposed regulations. Maldonado says the moves would be a big help. 

"I think coming about and fixing some of these problems are definitely going to make medications more accessible to patients."