Florida is fortunate to have one of the strongest and most active senior communities in the nation. Our state is home to seniors who want to enjoy their retirement with purpose: spending time with their families, volunteering in their communities, supporting local businesses, and pursuing healthy, independent lives. Every day, I hear from older adults how modern medicine, strong relationships with their doctors, and steady access to treatment help them stay active and engaged.
That’s why it’s so important that Florida carefully evaluates any proposals that affect the medications older adults depend on. Reducing costs is a goal we all share, but how we reduce costs is just as important as the results. And now, there is a provision in House Bill 697 that could unintentionally put older Floridians at risk of losing access to the very treatments that keep them healthy.
The proposal would tie Florida’s drug reimbursement to prices set by foreign governments, a concept often referred to as “most-favored-nation treatment” (MFN) or international reference prices. At first glance, it may sound like an easy way to cut costs. But the system that Florida is trying to mirror has severe access limitations that disproportionately impacts the elderly and people with chronic illnesses and disabilities. You need to be careful about such risks.
Many of the countries used in the MFN model rely on a metric known as quality-adjusted life years (QALYs). Although this term is technical, its impact is straightforward. QALYs assign a lower value to treating older people, people with disabilities, and people living with long-term illnesses. That’s why federal law prohibits Medicare from using QALYs to determine coverage, and no older person’s life should be said to be worth less on a spreadsheet.
Florida’s concern is not that the state Legislature intends to adopt QALYs. it’s not. The concern is that by tying Florida’s reimbursement to a foreign government’s price list, it implicitly imports the access limitations that those systems create, limitations that often result from decisions based on foreign QALYs. While the term may not be written into the law, older adults could feel the effects if access to essential medicines becomes difficult because reimbursement no longer matches real-world needs.
That’s not the outcome Florida State wants. And the good news is that there are other options to achieve the common goal of reducing costs.
Older adults need a system that reflects their dignity, recognizes their years of contributions, and protects the choices they make in collaboration with their physicians. We can move toward affordability without adopting foreign pricing structures that limit access or delay treatment. For example, Florida policymakers could require that the billions of dollars in discounts and rebates that PBMs and health plans receive from manufacturers be passed directly to Floridians at the pharmacy counter, rather than kept as profits. Policymakers could also work to ensure that copay assistance actually counts toward deductibles and out-of-pocket limits, which would make an immediate and meaningful difference for seniors on fixed incomes. It also allows PBMs to modernize their payment methods so that compensation is a fixed fee rather than tied to the drug’s list price. These are practical reforms that are producing results in the real world.
I am confident that Florida’s leaders, who have consistently stood up for seniors, will take the time to ensure that the reforms truly reflect the needs of the people they are intended to help. And, in a Floridian way, we can provide solutions that honor seniors and enhance the care they rely on every day.
Conwell Hooper is co-founder and executive director of the American Seniors Alliance.
