The Florida Office of Insurance Regulation (OIR) is facing scrutiny after demanding personal and prescription data from pharmacy benefit managers (PBMs), raising concerns over privacy and government overreach. The move has sparked debate about transparency in drug pricing versus the security of patient records.
State’s Request for Data Stirs Privacy Fears
The OIR has sent letters to PBMs requesting details such as names, birth dates, and prescription histories of potentially millions of Floridians. The request, first reported by Bloomberg on February 28, is part of an investigation into PBMs, which play a crucial role in determining which medications are covered by insurance and at what cost.
State officials argue that the request is part of their legal authority. Shiloh Elliott, spokesperson for the OIR, stated that the inquiry is within the “normal course of business in the examination process.” However, critics fear the data could be misused or leaked, jeopardizing patient privacy.
Michael Jackson, former CEO of the Florida Pharmacy Association, expressed public unease: “Consumers do not want the government to have access to their private details.” Others, like Miami-Dade County Public Schools benefits director Rosa Novo, acknowledged the need for lower drug prices but insisted that personal health details should remain between patients and their doctors.
Pharmacy Benefit Managers Under the Microscope
PBMs have long been accused of inflating drug prices while acting as intermediaries between drug manufacturers, insurance companies, and pharmacies. Florida Governor Ron DeSantis signed the Prescription Drug Reform Act in May 2023 to regulate PBMs and improve pricing transparency. The OIR’s current request seeks to determine whether PBMs are complying with the law.
Elliott pushed back against privacy concerns, arguing that the opposition comes from those “who do not want to be regulated or have any oversight in their industry.” PBMs process nearly 80% of all U.S. prescription claims, with three major players—CVS Health, Cigna, and UnitedHealth Group—dominating the market.
Critics Worry About Potential Government Overreach
While the OIR maintains that the data will remain confidential and is necessary for oversight, some experts fear the government may use it for unrelated political purposes.
- Health law specialist Sharona Hoffman speculated that Florida officials could exploit the data to monitor doctors providing reproductive or transgender care. However, no evidence has surfaced to support this claim.
- Transparency-Rx managing director Joe Shields said the request feels like “big government getting into people’s medicine boxes,” an approach he believes is out of step with most Americans.
- The American Benefits Council, which represents large corporations and financial institutions, has formally urged the OIR to withdraw its request, citing “impermissible violations of privacy.”
DeSantis Administration Defends the Oversight Effort
Governor DeSantis has framed the PBM crackdown as a battle against powerful industry players. “PBMs and Big Pharma have managed to escape the public eye and work in the shadows for far too long,” he said in a May 2023 statement. “I’m proud to sign a bill that takes the reins back from these healthcare monopolies while empowering consumers.”
Supporters of the OIR’s move argue that PBMs should not be able to hide behind patient confidentiality to avoid accountability. Jackson questioned why PBMs are resisting oversight: “What is it that the PBM industry doesn’t want you to know? Why are they hiding behind patient confidentiality?”
What Comes Next?
The OIR has indicated that it will continue seeking data to “act in the best interest of consumers.” However, with privacy groups, corporate lobbyists, and patient advocates all weighing in, the battle over patient data in Florida is far from over.
