Executive Insight

MICHAEL JACKSON, BPHARM, RETIRED EVP & CEO, FLORIDA PHARMACY ASSOCIATION

The Florida Legislature Has Gone Home – What Did They do?

Even as I transition into retirement, it is hard not to notice when the Florida House and Senate meet to discuss policy issues. After all, our profession exists because the Florida Legislature said it could by sustaining Florida laws under F.S. 465. Whenever there is tinkering under that code, there needs to be 35,000 Florida pharmacists and 56,000 Florida registered technicians who are interested. Any changes under that Florida law affects each of us directly.

One task that the Legislature must do each year is to review and pass the operating budget for the state. We are talking in excess of $110 billion in government funding. Health care is a very large piece of that dollar pie. For the 2022 legislative session, reports from the Capitol are showing that 3,685 bills were filed. There were 992 in the Senate and 2,693 in the House. Of those 3,685 bills, only 285 or slightly more than 7.7% of bills passing both chambers have been sent to the governor’s desk for signature.

Many of those bills that passed were adopted within the final week or so of the session. In this message to the membership, I am going to tease you with a preliminary report of what happened and why you should be interested. Detailed reports will be provided at the FPA convention where you will be able to talk directly with leadership and our lobbyists from Adams Street Advocates. You may even get a chance to talk with members of the Legislature who volunteered to marshal our issues through this maze of sausage making. PBM Reform

A common discussion in pharmacy meetings throughout Florida and the U.S. involve the subject of the PBM marketplace and what it means to pharmacy businesses. For the past several years the FPA has shared data with the state on the prescription drug benefit within the Medicaid Managed Care Program.

Our findings have shown some very

revealing and troublesome issues, including patient steering and preferential pricing to affiliated pharmacies. There were laws within the pharmacy practice act that created some basic auditing standards, however there was no enforcement mechanism to address PBM auditing abuses. The Board of Pharmacy had no jurisdiction to sanction PBMs for any violations of F.S. 465.188 (Medicaid Audits of Pharmacies) or F.S. 465.1885 (Pharmacy Audits; Rights). In House Bill 357 sponsored by Rep. Jackie Toledo of Hillsborough County, we successfully advocated for a change that moves these auditing standards under the umbrella of the Office of Insurance Regulations.

The FPA worked with a coalition called “Empower Patients.” This group focused its efforts on PBM education and reform and took to social media the message that something needed to be done. It was fascinating to see that members of the Florida House and Senate grow interest in this area. HB357 picked up 28 cosponsors in the House. This legislation passed with no objection in the House as well as the Senate and at the production of this article is headed to the governor’s desk for signature.

There was an additional issue includ-

Many of those bills that passed were adopted within the final week or so of the session. In this message to the membership, I am going to tease you with a preliminary report of what happened and why you should be interested.

Michael Jackson, B.Pharm, FPA CEO (Ret)

FPA STAFF

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610 N. Adams St. • Tallahassee, FL 32301 850/222-2400 • FAX 850/561-6758 Web address: www.floridapharmacy.org. ed in the Senate version of the bill that would have required a review of PBM market conduct, however we were running out of time during this year’s session and did not get that included in the bill headed to the governor.

What does this change mean for pharmacy?

The bill transfers the audit provisions in the Florida Pharmacy Practice Act to the Florida Insurance Code. It gives the Office of Insurance Regulation the authority to enforce these provisions as well as potential violations. HB357 also adds in the ability for pharmacies to appeal audit findings using dispute resolution programs through the Agency for Health Care Administration. There is also a $10,000 financial penalty for PBMs that fail to register with the Office of Insurance Regulation. Insurance plans and HMOs become accountable to PBM behavior.

Vaccinations by Pharmacy Technicians

During the current pandemic, emergency orders were issued by the Department of Health and Human Services granting authority for pharmacy technicians to administer COVID vaccinations. While these emergency orders superseded state laws, their duration is limited.

For the 2022 legislative session, HB1209 was filed to take the provisions of the Public Readiness and Emergency Preparedness Act (PREP Act) granted to the Secretary of the Department of Health and Human Services and code them into Florida laws. HB1209 and SB1892 were filed to begin making those changes. The bills were not identical and as such the FPA preferred the Senate version. We also advocated for changes to the pharmacist-to-intern ratio when administering vaccines, which currently is limited to 1:1. Ultimately, HB1209 passed both the Florida House and Senate with FPA preferred changes and is waiting to be signed into law by Governor DeSantis. What does this change mean for pharmacy?

HB1209 allows registered Florida pharmacy technicians to administer all vaccines listed under F.S. 465.189 after having completed a certification training program approved by the Board of Pharmacy after consultation with the Board of Medicine and Board of Osteopathic Medicine. Pharmacy technicians must also complete a two-hour continuing education program approved by the Board of Pharmacy.

The bill also amends the vaccines allowed to be administered by pharmacists and pharmacy technicians by referencing the CDC list published as of March 21, 2022, and removing the reference to April 30, 2022. The bill also limits the ratio of pharmacists to technicians AND interns to 5:1 when there are vaccines being administered. This means that at no time could there be more than five pharmacy interns, five technicians or a combination of both interns and technicians up to five under the supervision of a pharmacist. The bill further clarifies that the pharmacist entering into a protocol with a Florida licensed physician must maintain professional liability insurance.

Drug-Related Overdose Prevention

Under current Florida laws (F.S. 381.887) pharmacists can provide emergency opioid antagonists to patients or patient caregivers pursuant to a prescription or pursuant to a nonpatient specific standing order for auto-injection deliver or intranasal application.

These provisions were placed into Florida law to assist with the growing opioid epidemic. According to the Florida Attorney General’s Opioid Working Group, drug overdose is now the leading cause of non-injury related death in the United States. With the current pandemic, it has been found that opioid use disorders have begun to rise. Senate Bill 544 revised what pharmacists can do