Florida demands patient names, regulations of medication in the middleman

Tallahasee – corporate groups have privacy, after state supervisory authorities have requested detailed data on prescription drugs in Floridians, including the names and birth data of the patients and their doctors.

The Office for Insurance Regulation calls for the unusual data amount of Pharmacy Benefit data – the intermediate dealers of the healthcare industry, which governors Ron Desantis and others have accused the leaps of drug prices and monopolistic behavior.

This year, companies were asked to hand over hundreds of millions of transactions for every prescription drug that they filled in Florida in 2024.

The state did not answer when it was asked how many companies met. It said that the data better understand the practices of companies.

Industry groups have pushed back and argue that the supervisory authorities have not given a good reason why they need such detailed information.

The state's demand “inadmissibly violates the privacy and security of millions of Floridians,” the American Benefits Council wrote to the Florida insurance commissioner in February.

The organization, which asked the state to withdraw its application, represents hundreds of the largest companies in the world. Many of its members use the pharmacy argument managers to manage their employees' health plans, but some are insurers and pharmacies -benefits.

Pharmacy's critics said that the concerns about the privacy of the patients were appropriate.

But The Office for Insurance Regulation said that the application was “in the best interest to protect consumers”. Officials also affected critics.

“These” characterized concerns “clearly come from those who do not want to be regulated or have surveillance in their industry,” a spokesman told Bloomberg News, who first reported messages about the request.

The office wrote that it had no data injuries, while the healthcare industry was “the most understandable sector 2024”. (Hackers stolen HIV test results and other sensitive information about 729,699 Floridians last year in the Ministry of Health, a separate state agency.)

Another industry trading group has spoken to the view that the state uses the data to identify doctors that offer minors for illegal abortion services or transgender treatment. However, there is no evidence of this.

The Office of Insurance Regulation announced it to the Times/Herald requested the detailed information As the Pharmacy Benefit Manager industry examines for the first time, Many thanks to a law of 2023 that gives the state more control.

The takeover of pharmacies was a desantis priority. He bragged on The legislation of 2023 as an appointment against seniors during his failed president runs this year.

The data requested by the supervisory authorities in accordance with the new law could be used to uncover the functioning of one of the most improper parts of the inflated medical system.

“It is important to be thorough to set a baseline,” said spokesman Shiloh Elliott in a statement.

Pharmacy Benefit managers appeared in the 1960s when health plans for employees offer workers a new benefit: cover for prescription drugs.

Before that, the drugs were relatively cheap. The patients were able to meet their recipes in almost every pharmacy and pay out of their own pocket.

When insurance plans covered the recipes, they turned to the managers of the pharmacies performance recipient to process the claims and monitor the costs.

The purpose of the benefit manager was to reduce the costs by negotiating pharmacies and drug manufacturers to maintain the best prices for those Insurers and his patients.

Since then, the business model of the industry has changed drastically. Pharmacy Benefit managers created their own pharmacies, brought together with insurance companies and completed secret business with drug manufacturers, which increased the costs.

An examination of the New York Times last year showed that the pharmacy managers steer patients into more expensive drugs, calculate steep surcharges for the otherwise inexpensive medication and undress billions of dollars of hidden fees. Other state and federal supervisory authorities have raised similar allegations in recent years than has grown awareness of the industry.

The three largest pharmacy managers are owned by CVS Health, Cigna and Unitedhealth Group and process 80% of all recipes in the USA.

“People keep calling them the middlemen,” said Antonio Ciaccia, President of 3 Axis Advisors, an advisory company that examines the American drug delivery chain.

“You are the whole system at this time.”

Desantis urged the legislator in 2023 to dramatically increase the monitoring of the industry. From January this year, the law carried out the exams every two years in Florida in Florida.

For the supervisory authorities, it is not unusual to recognize information from the patients. For example, the Office of Insurance Regulation can access detailed information for patient and medical assistants for Medicaid recipients and employees.

But the data of the state The demand for pharmaceutical performance managers goes far beyond that to include self-insured plans from which companies are protected according to the federal law.

“There is a very clear authority of the Supreme Court that says that the state cannot do it,” said Ryan Temme, lawyer of the American Benefits Council.

However, the organization does not strive for legal steps to stop inquiries.

Companies have applied concerns regarding the privacy of the patient to combat the regulatory examination. In the early 2000s, they argued that the creation of a database of doctors who prescribe opioids would violate the relationship between doctor and patient. The database was finally created and helped identify doctors and pharmacies that abuse the system.

When the then General Ashley Moody 2019 asked for access to the data to sue pharmacies and pharmaceutical companies for these abuse, the legislator initially opposed similar reasons.

The data that Moody received did not contain the patient's birth dates. Instead, random ID numbers were assigned to the patients.

The Ciaccia company analyzed 350 million anonymized Florida Medicaid claims to create a report from 2020, in which it was found that pharmacy performance managers paid their own pharmacies much more for the output of medication than their competitors.

He said that it was not crucial for the names and birth dates of the patients for state supervisory authorities.

“I don't think it's worth getting patient names,” said Ciaccia.

Michael Jackson, a retired pharmacist and former CEO of the Florida Pharmacy Association, said the concerns about privacy are fair.

“Every consumer does not want the government to have access to their confidential information,” said Jackson.

As a former pharmacist who testified for the legislation of Florida 2023, he also questioned the motivations of the pharmacies.

“What does the PBM industry not want to know that you know?” Said Jackson. “Why do you hide behind the confidentiality of the patients?”

Times/Herald Tallahassee Bureau Reporter Alexandra Glorioso contributed to this report.