Over Half of Florida’s Community Pharmacies May Be Forced to Discontinue Participation in the State’s Medicaid Program

According to a recent survey of Florida independent pharmacies conducted jointly by PUTT and Small Businesses Aligned for Pharmacy Reform (SPAR), a Florida advocacy group, more than 60% of pharmacies surveyed may be forced to discontinue Medicaid if changes to the state’s current Medicaid reimbursement structure are not implemented soon. 

Survey results indicated that 93% of the 123 Florida pharmacies that responded have had to turn away at least one Medicaid patient per month because the loss per prescription was too great, and almost one-third reported having to turn away 10 or more patients per month for the same reason.

Results also showed that pharmacy benefit managers (PBMs), who have publicly claimed to ‘put patients first’ throughout the COVID-19 crisis, blatantly ignored Governor DeSantis’ early refill executive order and current Florida statutes on patient medications, denying authorization to 61% of respondents’ Medicaid patients for 90-day supply pre-fills and/or refills during the pandemic. 

According to the pharmacies surveyed, patient prescriptions most likely to be reimbursed at grossly below-cost levels include those for life-threatening conditions such as diabetes, HIV, mental health, and pediatric conditions - all drugs that fall into specialized, more expensive categories and create a substantially greater hardship on neighborhood pharmacies when required to dispense them at a loss.

If the results of this survey are any indicator, PBMs and their MCO counterparts are using the COVID-19 crisis as another way to reconfigure the healthcare industry into their own privatized profit machine.

The drug pricing model in a state-funded health plan needs to be transparent with rigorous oversight. Managed care can be non-transparent and deceptive, fooling taxpayers and consumers into thinking their medicine costs have somehow been contained, or “managed”. The survey shows that PBMs and MCOs are not obeying the law, are reducing patient access, and are forcing neighborhood pharmacies to lose money so they can maximize their record-breaking profits during a public health crisis.

The 50-question survey covered topics related to Florida Medicaid managed care reimbursements. Respondents were asked to describe the percentage of their business dedicated to Medicaid; average profit margin; estimated back-end and transaction fees (fees PBMs charge pharmacies to submit claims for reimbursement, appeal claims and other costs of business assigned by the PBM); effect on patients and on the future of their pharmacies. 

The Florida Medicaid MCO survey can be found here.