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DeSantis' executive order takes aim at pharmacy benefit managers and prescription drug costs

 Gov. Ron DeSantis at a press conference in Cape Coral July 8, flanked by Agency for Health Care Administration Secretary Simone Marstiller and Florida State Rep. Adam Botana (R-Bonita Springs)
The Florida Channel
Gov. Ron DeSantis talks at a press conference in Cape Coral flanked by AHCA Secretary Simone Marstiller and state Rep. Adam Botana, R-Bonita Springs.

The governor's order requires state agencies to review contracts with pharmacy benefit managers to ensure that costs are justified. He also expressed disappointment over the FDA's delay in approving Canadian drug imports.

Gov. Ron DeSantis announced a new executive order Friday aimed at adding transparency to the role of pharmacy benefit managers in administering prescription drug programs that he said may be contributing to increased medication costs.

At a press conference in Cape Coral, DeSantis also said the state could wind up in a legal battle with the U.S. Food and Drug Administration over the federal government’s delay in approving Florida’s Canadian drug importation program.

DeSantis said the executive order will hold pharmacy benefit managers more accountable. Pharmacy benefit managers act as a third party between insurance companies and beneficiaries to manage prescription drug benefits.

The governor's order requires state agencies to review their contracts with pharmacy benefit managers to ensure that their costs are justified. DeSantis said the order also aims to curb what’s known as spread pricing and claw-backs.

“Spread pricing is a deceptive practice where PBMs collect payment from the individual and keep leftover funds after they’ve already reimbursed the pharmacy for the prescription and the service cost. The practice essentially adds a middleman, and that practice drives up the cost for everyday Floridians,” DeSantis said.

“Claw backs occur when an individual overpays for their prescription and the PBMs keep the overpayment as a financial bonus.”

An audit commissioned by the Florida Agency for Health Care Administration shows that prescription benefit manager drug markup activity, including spread costs and administrative and other fees, cost the state’s Medicaid system more than $113 million dollars in 2020 alone.

Meanwhile, a bipartisan bill called the Pharmacy Benefit Manager Transparency Act of 2022 was recently introduced in the U.S. Senate that also aims to prohibit spread pricing and claw backs.

DeSantis also took aim at the federal government over ongoing delays in approving Florida’s request to enact a plan to import cheaper prescription medications from Canada. In 2019, DeSantis signed a drug importation program into law which would save Floridians an estimated $80 to $150 million dollars in medication costs.

The plan was approved by both President Joe Biden and former President Donald Trump, but the FDA has yet to green light it. AHCA Secretary Simone Marstiller said the state has made a Freedom of Information Act request to get to the bottom of the delay.

“Even when we’ve asked for particulars, we’ve been met with resistance and we’ve been promised follow-ups that we’ve never gotten,” said Marstiller.

“So, basically, we’ve gotten zero commitment from the FDA to get this done, notwithstanding their boss President Biden’s directive to work with the states to get it done. That’s why we’ve filed the FOIA request so we can find out exactly what’s going on.”

Marstiller said the FDA has already indicated it may not be able to meet a 20-day deadline for the FOIA request. DeSantis said he’s determined, as Florida has already set up a warehouse in Polk County to facilitate the drug importation program.

“We’re still in this fight. We may even end up in litigation over this potentially, but we were happy to lead the way. Other states like Colorado and others have also wanted to do this as well,” said DeSantis.

DeSantis also took a shot at the Biden administration in suggesting the delay could be politically motivated.

“Now maybe they just don’t want to give Florida a win and that wouldn’t be surprising, knowing what they’re doing,” said DeSantis.

“It may be that Pharma has told them they don’t want this, but you know, we’ve got to stop doing policy just on the basis of what Pharma wants. I mean, we’ve got to do policy on the basis of what people think is the best.”

The governor has previously said AHCA could begin importing prescription drugs from Canada within 90 days, once the program gets federal approval.

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John Davis has been a full-time Reporter/Producer for WGCU since 2009. He is the local host for NPRââââ