Editor's Note: This article was updated 3:32 pm February 6, 2020 with additional information.
A new report from the Florida Pharmacy Association and American Pharmacy Cooperative, Inc, alleges that pharmacy benefit managers (PBMs) in the state are favoring their own affiliated pharmacies in the Florida Medicaid program, both by driving customers to those pharmacies and by reimbursing them at higher rates.1
"This report reinforces the need for Congress to reform Medicaid managed care," said National Community Pharmacists Association CEO B. Douglas Hoey, RPh, MBA, in a statement.2
Although the cost-of-dispensing (COD) incurred by pharmacists in Florida is $10.24 per claim, according to the state's COD analysis, this required pharmacy reimbursement methodology does not apply to Medicaid managed care organizations (MCOs) that contract with PBMs. The report's analysis of Florida's top 7 MCOs found that pharmacies were paid a weighted average of $2.72 per claim in 2018—significantly lower than the $10.24 COD and down from $7.70 in 2014.1
The authors noted, however, that not all pharmacies seem to be experiencing this pressure equally. In 2018, the state's 5 largest specialty pharmacies collected 28% of the available profits paid to all providers in Florida Medicaid managed care, despite dispensing just 0.4% of all managed care claims.1
Based on these findings, the authors wrote, "MCOs and PBMs appear to be using their control in managed care to incrementally shift dollars to their affiliated companies."1
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