Testimony of Robert Levin, MD - Senate Bill 1550 - Florida Committee on Health Policy

Senate Bill 1550 - Committee on Health Policy

Monday, March 27, 3:00PM

Testimony

Robert Levin, MD

Chair Burton, Vice-Chair Brodeur, and members of the Committee on Health Policy, thank you for allowing me to speak here today in support of Senate Bill 1550.

My name is Dr. Robert Levin, and I am from Clearwater, FL, where I have been a practicing rheumatologist for the last 34 years. I am the advocacy chair of the Florida Society of Rheumatology and the current President of the Alliance for Transparent and Affordable Prescriptions, which works on patient access issues related to prescription drugs costs in all 50 states, including the federal level.

Rheumatologists treat patients that often require specialty medications that can be hard to access. One of the main reasons for this struggle is that patients are paying an inflated price for their specialty medications.

Thankfully, our Governor recently called out the people responsible for profiteering off the backs of chronically ill patients in Florida.

Pharmacy… Benefit… Managers… or PBMs.

There is a reason why the Federal Trade Commission (FTC) ordered an investigation into PBM practices last summer. Specifically, the FTC “announced that it will ramp up enforcement against any illegal bribes and rebate schemes that block patients’ access to competing lower-cost drugs.”

In theory, PBMs should greatly benefit patients and plans alike. They constantly talk about cost savings they provide for patients and employers. However, PBMs operate differently in practice. They promise employers lower costs but do so to drive their employees to preferred drugs that make them the biggest profit.

While PBMs are indeed successful in extracting discounts and price concessions, PBMs fail to pass along the bulk of these concessions to patients or plans. They instead retain those savings for themselves.

They construct drug formularies to give preferential treatment to drugmakers who pay the highest rebates and fees. Those payments are again primarily diverted to the PBMs’ own bottom line, rather than defraying the costs of care.

These profit-driven activities distort the healthcare market and limit a patients access to prescription drugs, especially where formulary decisions are driven by a PBM’s profit potential instead of medical necessity or accepted clinical standards.

Yet PBMs avoid scrutiny by resisting transparency and hiding conflicts of interest, making it difficult for industry stakeholders to detect or address PBMs’ abuse of market power.

The end result is the opposite of what PBMs were originally designed to achieve. They have become massive profit centers while, ironically, increasing patients’ out-of-pocket costs, interfering with doctor-patient relationships, and impairing patient access to appropriate treatment.

Senate Bill 1550 is to be considered historic in reforming these abusive PBM practices. The legislation addresses transparency and provides protections to help provide relief for lower drug prices.

However, there is one issue that non dispensing practices in Florida, like mine, would like to see added to help provide protections for patients and providers who require infusions. PBMs have recently implemented another abusive practice known as “white bagging”, which steers patients to specialty pharmacies often owned by the PBM.

Traditionally, my practice has handled the purchase, delivery, storage, and administration of infused specialty medications for patients. However, PBMs are now starting to require that they handle the purchase and delivery of these drugs.

Unfortunately, the specialty pharmacies they coordinate with frequently make mistakes that delay care for my patients and create numerous logistical hassles.

However, even more concerning to me is the amount of waste this change has generated. The drugs must now be assigned to a specific patient and date range prior to administration when they are dispensed by the specialty pharmacy working with the PBM.

As a result, I am legally unable to alter or assign the drug to a different patient. If a patient requires a change in therapy or even a change in dosing, the drug provided by the PBM will end up as waste.

Lastly, thank you to sponsors of this pro-patient legislation. It really takes dedication to stand tall against healthcare giants that rank #4, #5, and #12 on the fortune 500 list.  Please vote YES on Senate Bill 1550.

Thank you.