Here’s how Florida’s pharmacy benefit manager system hurts patients | Column
Often called PBMs, the middlemen “manipulate the system to the detriment of patients.”
State lawmakers have an opportunity to take a giant leap toward curbing abuses in the pharmacy benefits manager system.
State lawmakers have an opportunity to take a giant leap toward curbing abuses in the pharmacy benefits manager system. [ JUPITERIMAGES | Tampa Tribune ]
Published April 6

Health care is complicated. But for many patients, it’s made even more complicated and challenging by middlemen called pharmacy benefit managers — or PBMs — who often manipulate the system to the detriment of patients.

Michael Diaz
Michael Diaz [ Courtesy of Michael Diaz ]

Fortunately, state lawmakers have an opportunity to take a giant leap toward curbing these abuses and putting Florida patients first.

PBM middlemen insert themselves into the decision-making process between a doctor and a patient, regularly making critical decisions about when, what and how a patient can receive care and treatment. They do all this without having any medical training or background.

Let me explain.

I’ve practiced oncology for decades and have worked with countless patients who are in the fight of their life battling cancer.

I remember one young patient who was fighting a particularly aggressive form of cancer. His doctor prescribed a medication that could have been filled down the hall from where the patient was undergoing treatment. However, the PBM insisted that the medication arrive via mail from a pharmacy of its choosing hundreds of miles away. The paperwork, errors and bureaucracy caused weeks of delays. By the time the life-sustaining medication reached this patient, his cancer had progressed to a point where he was not a candidate for any further treatments.

In another case, a patient had metastatic cancer, and physicians recommended an oral medication. When the treatment plan was submitted to the PBM, they rejected it and amended the plan to incorporate surgery — even though the patient’s own surgeon did not recommend that approach. The issue took weeks to resolve and resulted in a tremendous amount of avoidable confusion.

In one final example, the PBM forced a patient to purchase more of a medication than their physician prescribed just because that’s what the PBM’s counterintuitive policies required. For specialized oncology medications, that can end up costing patients thousands of dollars that they didn’t need to pay.

The reality is that heartbreaking stories like this, where patient choice is tossed aside, are all too common — but they don’t have to be.

Gov. Ron DeSantis is advocating for reforms that would make a world of difference for patients across the state. A pair of legislative proposals — SB 1550 by Sen. Jason Brodeur and HB 1590 by Rep. Linda Chaney — would help strengthen patient choice, lower drug prices and enhance accountability. It’s just what we need right now.

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At the end of the day, patients should have the freedom to choose which pharmacy they want to use. No one should pressure them to pick a different one simply because profit margins might be higher. The manipulation must stop.

The Florida legislative session is underway, and these bipartisan bills still have several hurdles to clear before becoming law, but patients and physicians should be encouraged. We’re finally starting to see the types of reforms that are necessary to put Florida patients first.

I hope you’ll join me in advocating for legislation that will lower drug costs and increase patient choice. After all, health care doesn’t need to be this complex.

Michael Diaz is an oncologist who lives in St. Petersburg. He serves as the director of patient advocacy for the Florida Society of Clinical Oncology (FLASCO).