Committee advances bill to curb PBM audit practices and conflicts of interest
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Summary
SB 1256 would standardize pharmacy audits by PBMs, limit frequency and scope, and require proportional penalties; pharmacists testified the bill is needed to prevent conflicts where PBMs own retail pharmacies and to protect community pharmacies from burdensome audits.
The Banking and Insurance Committee reported Senate Bill 1256 favorably after sponsor remarks and testimony from pharmacists and pharmacy associations.
Senator Grama said SB 1256 would ensure PBM audits of pharmacies are conducted uniformly, transparently and fairly across independent, PBM-owned, and PBM-affiliated pharmacies by setting standards for audit scope, frequency, and penalties. The sponsor said the bill preserves authorities to pursue fraud while creating due-process protections for pharmacies during audits.
Pharmacist Kevin Duane told the committee that, under current practice, “there's no limits on audit frequency or audit scope,” and that three companies control roughly 80% of the insurance market while also owning PBMs and pharmacies — a structure he said can create conflicts of interest. Duane warned audits can become “fishing expeditions,” impose crippling paperwork, and push patients away from community pharmacies. He added that criminal fraud investigations (for example by Medicaid fraud control units) are excluded from the bill’s limits.
Representatives of the Florida Pharmacy Association waived in support, and the sponsor closed. The committee took a roll call and reported SB 1256 favorably to the Senate.