TALLAHASSEE, Fla. - Starting July 1, pharmacists across the state of Florida will finally be able to tell patients if they can save money on their medications by paying cash or by using insurance.
That's something pharmacists weren't able to voluntarily do before, unless patients flat out asked.
A contract they signed with insurance and drug companies prevented pharmacists from being able to mention if patients could get medications for a better price.
This "gag clause" kept many pharmacists from being able to be fully transparent with the customers, and that frustrated Dr. John Roger Acardi.
"There's so many people that are on fixed incomes that $2, $3 or $4 is notable," Acardi said.
Acardi has been a pharmacist for 50 years and runs a small, family-friendly pharmacy in Orange City. He said he hated not being able to tell his customers if there was a way to save them money.
That scenario caught the attention of Rep. David Santiago, who drafted House Bill 351 to change that practice.
The bill asked for prescription drug pricing transparency and, in doing so, asked that it be required of pharmacists to inform customers of certain generically equivalent drug products and whether cost sharing obligations to such customers (namely insurance co-pays) exceeded the retail price of the prescription. The bill also calls for pharmacy benefit managers to register with the state.
Both Santiago and Acardi said it wasn't the pharmacies making the big profits in the price discrepancies. It was the pharmacy benefit managers, or PBMs.
That's because PBMs act as a middle man or broker and negotiate the contracts between the insurance companies, pharmacies and drugmakers, and whenever someone's insurance copay was higher than the negotiated cost of the drug, the PBMs would get a clawback. Santiago said that led to billions of dollars in profit.
"The assumption was that they had the best deal negotiated by their insurance carrier," Santiago said. "And that was not the case."
According to Pharmacy-staffing.com, in 2017 it was estimated that approximately 300,000,000 Americans currently have a PBM in some way managing their pharmacy benefits. There are more than a dozen PBM companies operating in the United States, but the three "Super PBMs" account for an estimated 80 percent of all coverage. Between them they have a total enrollment of nearly 200 million patients.
The three largest, or "Super PBMs," (ranked by the total number of patients that are enrolled) include the following:
1. Express Scripts
2. CVS Health (formerly CVS Caremark)
3. United Health (also referred to as OptumRx & Catamaran)
The website, which is run by HealthCare Consultants Pharmacy Staffing, states the primary purpose in the establishment of pharmacy benefits managers was to maximize the purchasing power for large groups of patients, resulting in a price reduction for their prescriptions and medications. The website states PBMs primarily try to accomplish this goal by using their volume buying power and receiving rebates and discounts from the various pharmaceutical drug manufacturers. However, they also sometimes imposed strict limits on which pharmacies were allowed to participate in certain programs and for certain medications.
"These companies are among the largest companies we have in our nation," Santiago said.
Santiago says at first, the PBM lobbyists voiced strong opposition to the bill he drafted, telling him that it wouldn't see the light of day and would be squashed in committee.
But he says he continued to move forward -- making it a modern day version of David vs. Goliath -- with consumers being the ultimate winners when the bill became law.
Santiago says the bill had bipartisan support, and passed unanimously in the Florida House and Senate. Gov. Rick Scott signed it into law March 23.
And Acardi is glad he no longer has to follow a code of silence.
"It's going to make a difference, and to a large measure its going to give a lot of hope," Acardi said.
Florida now joins more than a dozen other states that are outlawing the practice of clawbacks.
Below is a graphic from Bloomberg research that illustrates how clawblacks work.
Until the law takes effect this summer, pharmacists encourage people to ask them if there is a way to save on their prescription medications.
Earlier this month, News 6 showed another way people can shop around for the best price on prescription medication using several popular apps, websites and other savings programs.
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