Florida to scrutinize pharmacy benefit managers over drug costs

CAPE CORAL — Calling for more “transparency” in prescription-drug costs, Gov. Ron DeSantis on Friday issued an executive order designed to increase scrutiny of pharmacy benefit managers.

The executive order, in part, will require audits of pharmacy benefit managers that provide services in the state’s Medicaid managed-care program and the state-employee health insurance program. Pharmacy benefit managers act as sort of middlemen and play roles such as representing insurers in negotiations with drug companies and pharmacies.

“This is 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 review of potential inflation of dispensing fees and payments from drug manufacturers, insurers and pharmacies, as such pertain to a Medicaid managed care plan,” the executive order said. “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 put certain stipulations in new, renewed or extended contracts that involve pharmacy benefit managers. For instance, one of those stipulations would prevent “clawbacks,” which the executive order said involve situations when pharmacy benefit managers retain money that is recouped from overpayments to pharmacies. DeSantis last month signed a bill (HB 357) that also seeks to increase oversight of pharmacy benefit managers. The bill included giving the Office of Insurance Regulation more authority over pharmacy benefit managers. Small pharmacies, which have long complained about pharmacy benefit managers, lobbied for the bill.