The Solution

Require insurers and pharmacy benefit managers (PBMs) to share the benefit of rebates and negotiated discounts directly with patients at the point-of-sale.

Health insurance companies and PBMs negotiate significant rebates and discounts when purchasing medications from drug manufacturers, but fail to pass those rebates and discounts on to patients. As a result, many insured people in Florida with chronic conditions are paying nearly double what their insurer is paying for lifesaving and life-sustaining medication.

But, there’s a simple solution – require insurers and PBMs to share the savings of rebates and negotiated discounts directly with patients at the point-of-sale.

Eliminate copay accumulator programs to ensure that all money paid toward prescriptions on behalf of a patient count toward the patient’s out-of-pocket maximum and annual deductible.

With deductibles and out-of-pocket costs soaring, many patients rely on financial assistance from drug companies and non-profits to access their medications. Unfortunately, many PBMs and insurers are taking assistance intended for patients, and have stopped counting the amount provided by copay assistance programs toward a patient’s deductible and out-of-pocket maximum. This policy is referred to as a “Copay Accumulator Adjustment” policy. Today, nearly all insurers in Florida have copay accumulator adjustment policies, according to a report by The AIDS Institute.  

States have the authority to block copay accumulator adjustor policies in state exchanges and certain private health insurance plans, and many states have implemented this change. Although not all patients are protected by these laws, and a federal solution is still needed, these state actions are helping millions of patients.

Streamline Utilization Management protocols, like step therapy, prior authorization, and non-medical switching, to ensure patients access to the right medicines at the right time.

Healthcare professionals have the expertise to know what is best for patients and must have access to a full range of therapeutic options to use as they see fit for their patients. They should not have to jump through burdensome bureaucratic hoops to secure the most appropriate therapy. Unfortunately, health insurers and PBMs have created “Utilization Management” tools to ultimately decide what medications and treatments you have access to, when you can access them, how much you pay for them, and even which pharmacy you can use.

Healthcare professionals, not bureaucrats, should make the determination of the best course of treatment and medications for a patient. We need to ensure Florida’s patients are receiving the right medicine at the right time – and state policymakers play a pivotal role in streamlining utilization management protocols.

Ensure federal and state programs designed to support patients work as originally intended – to improve access and health equity for the communities served.

In 2018, hospitals, health insurers, PBMs, the government, and others received close to a 50% profit of what was spent on brand medicines. We are asking for these profits to be shared with patients.

We’re committed to monitoring federal and state programs to ensure they work as originally intended – to improve access and health equity for the communities these programs are intended to served.