Senate committee advances broad Medicaid oversight, PBM transparency and managed‑care changes
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Summary
The committee adopted a strike‑all that creates a joint legislative Medicaid oversight body, tightens managed‑care income‑sharing (ASR) rules and adds transparency and limits on PBM practices amid debate from pharmacies, PBM groups and CVS Health.
The Florida Senate Committee on Health Policy voted to report favorably a sweeping Medicaid oversight package that would create a joint legislative Medicaid oversight committee, change reporting for prepaid plans, alter profit‑sharing formulas for managed‑care plans and increase transparency and limits around pharmacy benefit managers (PBMs).
Sponsor Senator Broder described the bill as aimed at “transparency, accountability and fiscal responsibility” for what he noted is an almost $40 billion program. “As those who write the checks, it would be really nice to have our own backup actuary,” he said, describing new legislative oversight and adjustments to how shared savings (ASR) are calculated and returned to the state.
A central focus of debate was PBM behavior and affiliated‑party transactions. The bill would require enhanced reporting of related‑party arrangements and curtail certain practices the sponsors described as “games” that shift revenue into uncapped service lines. Independent pharmacists, represented by SPAR, told the committee that opaque PBM contracting and offset practices are forcing community pharmacies to close; Barney Bishop said Florida is losing small pharmacies at a rapid pace. The Pharmaceutical Care Management Association (PCMA) and major pharmacy companies asked for further negotiation, warning that some provisions could affect biosimilar adoption or disrupt specialty‑pharmacy contracting.
Senators expressed broad interest in the measure’s potential to reveal where realized savings have accrued and to ensure more of those savings benefit taxpayers and patients. After extended debate and witness testimony, the committee reported the bill favorably as a committee substitute.
