Florida to scrutinize benefit managers on drug costs


CAPE CORAL — Calling for more “transparency” in prescription drug costs, Gov. Ron DeSantis issued an executive order Friday aimed at increasing scrutiny of drug benefit managers.

The executive order will in part require audits of drug benefit managers who provide services under the state’s Medicaid managed care program and state employee health insurance program. Pharmacy benefit managers act as something of an intermediary and play roles such as representing insurers in negotiations with pharmaceutical companies and pharmacies.

“It’s an incredibly opaque process,” DeSantis said during an appearance in Cape Coral to announce the executive order.

The audits, for example, will include “a detailed examination of potential inflation in dispensing fees and payments to drug manufacturers, insurers, and pharmacies, as such pertaining to a Medicaid managed care plan,” says Decree. “The purpose of this audit is to ensure that all costs incurred by the State of Florida are justified.”

The executive order also requires state agencies to include certain terms in new, renewed, or extended contracts that involve pharmacy benefit managers. For example, one of those stipulations would prevent “clawbacks,” which the executive order says involve situations where pharmacy benefits managers keep money that is clawed back from overpayments to pharmacies.

DeSantis signed a bill (HB 357) last month that also seeks to increase oversight of drug benefit managers. The bill planned to give the Office of Insurance Regulation more authority over drug benefit managers. Small pharmacies, which have long complained about drug benefit managers, lobbied for the bill.

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