Lazaro Aleman
ECB Publishing, Inc.
A controversial health insurance bill that the governor champions and that the Senate passed earlier in April, was scheduled to be heard in full House this week.
House Bill 1509, whose slightly different companion is Senate Bill 1550, is said will potentially increase health insurance costs in the commercial market, state group health plans and Medicaid. The bill, however, reportedly enjoys wide support from hospitals, pharmacists and community pharmacies.
It’s reported that an actuary from Florida Blue estimated an $81.9 increase to its commercial health plans pharmacy benefits if the legislation were to be approved, with most of the increase attributed to an expansion of the pharmacy networks. The rule generally is that pharmacies provide better pricing for narrower networks.
Another actuary from the Sunshine Health Plan estimated that a broadening of its managed care plan pharmacy network would add $24 million to its costs.
Meanwhile, it’s reported that the Department of Management Services, which oversees the state group health plan, estimates that the changes for specialty drugs would increase the state group health insurance plan’s pharmacy costs by $2.2 million.
Critics point out that employers, insurers and state taxpayer pay the benefits, and ultimately they will pay for the increases, as with consumers over time through higher premiums and diminished benefits.
The idea to regulate pharmacy benefit managers (PBMs) surfaced after an earlier plan to import cheaper drugs from Canada failed to get immediate federal approval.
It’s reported that both the House and Senate bills require PBMs to obtain a certificate of authority from the Florida Office of Insurance Regulation (OIR) by Jan. 1, 2024. The bills further require the OIR to submit a report to the governor and legislature detailing compliance with the law.
The bills also require drug manufactures to notify the state of certain increases in drug prices if a drug costs at least $100 “to complete a course of treatment and the prices increase by 15 percent of more during the preceding 12 months; or 30 percent or more over a three-year period.”