ICYMI: This opinion piece appeared in the Tallahassee Democrat on March 26, 2023
Opinion Editorial by Helen Sairany
Executive Vice President and CEO, Florida Pharmacy Association
Coalition Member, EMPOWER Patients
“Why don’t you pick on somebody your own size?”
This simple question has transcended generations, intended to remind those in positions of power, from playground bullies to oligarchs, to be aware of the inherent advantage they have over others and resist exploiting it for personal gain. Of course, picking on or victimizing anyone is wrong, regardless of their size or status, but when a matchup is so drastically different and the “little guy” doesn’t stand a chance, it’s not just wrong, it’s unethical.
Through my experiences as a global pharmacist, a national leader in the pharmacy industry, and now a member of the EMPOWER Patients coalition here in Florida, I have found that these grossly one-sided relationships can exist seemingly anywhere, even in the prescription drug supply chain. In my line of work, they’re perpetuated by multi-billion-dollar companies known as pharmacy benefit managers, or PBMs, that prey on innocent patients – everyday men and women who rely on medication to mitigate their pain or cure their illnesses – as well as smaller independent and community pharmacies.
As middlemen between drug manufacturers and health insurers, PBMs decide which prescriptions to cover based on the size of the rebate they will receive, which has been shown to drive up patients’ out-of-pocket costs by almost 30 percent. Then, they use pressure tactics to steer patients to their affiliated pharmacies. For instance, CVS Caremark – one of the three PBMs that maintain approximately 80 percent of the prescription drug market – owns CVS Pharmacy and may only cover prescriptions filled there, no matter how inconvenient, time consuming, or more expensive it may be for patients. Basically, PBMs don’t provide any health care services, and yet they’re calling the shots, compromising patient care so they can continue increasing their already exorbitant bottom line.
And it’s no better for the hard-working independent and community pharmacy owners and their dedicated employees. PBMs are forcing them into “take-it-or-leave-it” contracts, sending them surprise bills and retroactive fees, and also subjecting them to spread pricing, which allows PBMs to charge more than the cost of a prescription and pocket the difference. As a result, PBMs can end up making up to 109 times more profit, and in many cases, these neighborhood pharmacies have no other option than to shut their doors, leaving their longtime customers – their friends and family – without access to the prescriptions they need.
While the Florida Legislature made great strides to regulate PBMs last year, Governor Ron DeSantis still wasn’t satisfied. In July 2022, he issued Executive Order 22-164 to address the more egregious transgressions of PBMs, and the following January, he introduced a legislative proposal – the most comprehensive prescription drug reform in Florida history – to codify those provisions in statute.
Now, during the 2023 Legislative Session, Governor DeSantis’ PBM proposal is being championed by state Sen. Jason Brodeur (R-Lake Mary), who is sponsoring Senate Bill 1550, and state Rep. Linda Chaney (R-St. Petersburg), who is sponsoring House Bill 1509. Both referred to as The Prescription Drug Reform Act, these bills underscore the opportunistic and, frankly, deplorable actions of PBMs, while reaffirming the need for increased transparency and accountability in the prescription drug market.
If either bill passes, it will prohibit patient steering, while designating an employee at the Department of Financial Services to intake and process patient complaints related to PBMs. Among other things, it would also ban spread pricing and instead require pass-through pricing, a practice that levels the playing field for independent and community pharmacists and ultimately helps reduce patient costs.
The EMPOWER Patients coalition is sincerely grateful to Governor DeSantis, Sen. Brodeur, and Rep. Chaney for the work they have done so far to rein in PBMs, and we look forward to supporting them as they establish critical, long-overdue change on behalf of patients this session.
Thank you, leaders, for taking on these corporate giants and standing up for the little guys.
Helen Sairany is Executive Vice President and CEO of the Florida Pharmacy Association and a member of EMPOWER Patients, a coalition comprised of patients and independent and community pharmacists and pharmacies focused on increasing access to affordable medication by drastically scaling back the role of pharmacy benefit managers (PBMs) in the prescription drug supply chain.