Medicaid Pharmacy Services:
SB 1628 would substantially change how Florida Medicaid pays for pharmacy services. The bill removes the requirement that Medicaid managed care plans cover prescription drug services and instead directs the Agency for Health Care Administration to provide pharmacy benefits directly through a fee-for-service model for all Medicaid recipients beginning July 1, 2025. It also requires the agency to set reimbursement rates, dispensing fees, and supplemental rebates, and to adopt rules to implement the new system.
The bill would shift Medicaid prescription drug administration away from managed care plans and into a statewide fee-for-service structure, while preserving and expanding the state’s existing drug-cost controls. It keeps the preferred drug list, prior authorization, step therapy, drug utilization review, and rebate negotiation tools, and it authorizes the agency to manage pharmacy networks, dispensing limits, and return-and-reuse programs. The measure also makes conforming changes to Medicaid benefit and reimbursement statutes so that pharmacy services are handled directly by the state rather than through managed care plan coverage requirements.
The bill would amend sections 409.973, 409.908, and 409.912, Florida Statutes, to remove prescription drugs from the minimum benefits that Medicaid managed care plans must cover and to require AHCA to reimburse pharmacy services directly under fee-for-service. It would apply to all Medicaid recipients regardless of prior managed care enrollment, and it would require the agency to establish payment rates, dispensing fees, supplemental rebates, and implementing rules. The bill would also reinforce the agency’s authority over Medicaid drug management tools such as preferred drug lists, prior authorization, step therapy, and pharmacy network management, affecting Medicaid recipients, pharmacies, prescribers, managed care plans, and drug manufacturers.
The available context suggests the bill was not advanced out of committee and ultimately died in the Senate Health Policy Committee, indicating limited legislative support. Because there are no recorded committee transcripts or votes in the provided material, there is no detailed public record here of debate or floor sentiment. The bill’s structure, however, reflects a policy preference for state-administered pharmacy benefits and stronger centralized cost control within Medicaid.
The main point of contention is the bill’s move away from managed care plan responsibility for prescription drug coverage and toward direct state administration through fee-for-service. Supporters would likely view this as a way to standardize pharmacy benefits and improve state control over drug spending, while opponents could argue it disrupts managed care integration, increases administrative complexity, or shifts costs and operational burdens to the state. Additional likely friction points include the bill’s continued use of preferred drug lists, prior authorization, step therapy, and network limits, which can affect access for beneficiaries and business interests for pharmacies and manufacturers.