Matt Nye, a candidate for Florida House District 52, is voicing concern for independent pharmacies impacted by problems with unfair drug pricing in the Medicaid system by pharmacy benefit managers (PBMs).
Nye held a press conference last month at Lordoni Discount Pharmacy at 6300 N Wickham Road, No. 126. It is owned and operated by Nye’s friend, Olu Oni.
"Independent pharmacy owners like Olu are an essential part of the fabric of our local communities but, if things don’t change, there is a very real possibility that independent pharmacies like Olu’s won’t exist much longer,’’ Nye said during opening remarks.
The problem with PBMs, which are supposed to provide value by working behind the scenes to keep drug prices low, actually are not keeping costs down, according to the findings of a recent study. The study by 3 Axis Advisors used data from the state Agency for Health Care Administration (AHCA) to analyze Florida’s Medicaid managed care system.
The report analyzed 359 million individual prescription claims and more than 100 pharmacies participated in the analysis verification of prescription claims from 2012 through June 2019.
"The PBMs have been gaming the system with government plans — paying the pharmacies they own more, and forcing their competitors — like my friend Olu — to sell prescriptions at cost, or even at a loss,’’ Nye explained.
Florida’s Medicaid program involves total payments of more than $12 billion per year, with 20 to 25 percent of this amount paid to pharmacies by managed care organization, or MCOs, he said.
"The current system places a massive amount of money in the hands of a small group of MCOs, and these are taxpayer dollars that are being squandered,’’ Nye said.
The study results show significant prescription drug pricing concerns within Florida’s Medicaid program that have a direct negative impact on pharmacies, patients and taxpayers. In essence, the current system does not treat all pharmacies equally nor allow them to compete on an even playing field. Instead, vertically integrated companies gain a significant advantage that allows them to set arbitrary prices for competing pharmacies and steer patients to PBM-affiliated pharmacies, he said.