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Health News Florida

House Panel Scales Back Bill On Pharmacy Benefit Managers

A pharmacist pours Truvada pills, an HIV treatment, back into the bottle at Jack's Pharmacy in San Anselmo, Calif.
The measure deals with what is known as “step therapy” protocols, which generally involves trying lower-cost drugs first before moving to other more-expensive treatments.

An amendment removed a provision that would have allowed state insurance regulators to audit pharmacy benefit managers, insurance companies and HMOs.

A House panel Tuesday approved health care measures that deal with pharmacy benefit managers and what is known as “step therapy” protocols, but it made changes that narrowed the pharmacy benefit managers bill (HB 1155).

“Everything of substance has been taken out. Everything that would actually do something has been taken out. This bill has been so neutered so much it doesn’t even have a gender any more,” said Barney Bishop, a lobbyist for a group called Small Business Pharmacies Aligned for Reform.

As initially filed, the bill would have allowed state insurance regulators to audit pharmacy benefit managers, insurance companies and HMOs.

The initial bill also would have made clear that industry contracts prohibit pharmacy benefit managers from charging fees to pharmacists related to payment of pharmacy claims and from retroactively denying, holding back or reducing payments for covered claims.

The initial bill also would have given the state Office of Insurance Regulation access to utilization records and data and information used by pharmacy benefit managers.

An amendment Tuesday deleted those provisions.

The bill would transfer issues dealing with pharmacy benefit managers from laws regarding pharmacists to laws governing insurance companies and HMOs. The transfer is needed because pharmacists are regulated by the Florida Board of Pharmacy, which has no authority over insurance companies and pharmacy benefit managers

As amended, the bill also would beef up current laws by establishing a $10,000 financial penalty for any pharmacy benefit manager that doesn’t register with the Office of Insurance Regulation.

According to a legislative staff analysis, regulators haven’t been able to enforce a mandatory registration requirement first passed by lawmakers in 2018 because they didn’t have authority to levy fines.

Rep. Mike Caruso, R-Delray Beach , said he was disappointed in the amended bill and called the $10,000 penalty for pharmacy benefit managers that fail to register with the state “a joke.”

Caruso also said, “There’s just so many issues out there it fails to address,” adding, “I hope we come back next year and hit it again.”

The House panel also backed a proposal (HB 1001) that would require insurers or HMOs to publish online and provide to customers in writing procedures for patients and health care providers to request exemptions from “step therapy” protocols. Step therapy generally involves trying lower-cost drugs first before moving to other more-expensive treatments.