Florida insurance regulators have asked companies to hand over extensive amounts of data on people’s pharmacy claims, including personal information and prescription drug usage, an unusual move for a state regulator that’s raising privacy concerns.
An eight-page request went out in recent weeks to pharmacy benefit managers seeking detailed information on pharmacy contracts, claims and payments, according to copies of the request viewed by Bloomberg News. Pharmacy benefit managers operate the prescription drug benefits part of insurance plans, including workers’ compensation insurance, in most states.
The state asked for files that contained people’s names, dates of birth, the drug that was dispensed, the provider who prescribed the medication and the pharmacy that dispensed it, among many other data fields.
The request sought data on Florida residents as well as people from other states who filled prescriptions in Florida anytime during 2024. The state’s Office of Insurance Regulation asked for the information by Feb. 21. It’s not clear how many companies have provided data.
The breadth of the ask and the personal information requested raised alarms for some in the industry.
“The notion that big government is going to be in anybody’s medicine box is not something that I think is reflective of where most Americans are at,” said Joe Shields, managing director of Transparency-Rx. The trade group represents smaller pharmacy benefit managers that bill themselves as more transparent than the large companies that dominate the industry.
When asked about the privacy issues the data request raises, the Office of Insurance Regulation said in an emailed statement that such concerns are coming from “those who do not want to be regulated or have any oversight in their industry.”
“Any concerns about privacy implications should be addressed to the actual health-care insurance companies that have had countless data breaches exposing millions of Americans’ sensitive information,” a spokesperson said, noting OIR “will continue to request data in the best interest” of consumers.
Florida enacted a new law to regulate drug benefits middlemen in 2023. The companies run prescription drug plans on behalf of employers, unions and insurers. The industry has come under scrutiny for whether their arrangements with drugmakers and pharmacies drive up costs for patients and employers.
The agency’s request risks exposing sensitive data about patients’ mental health treatments or reproductive care, Shields said. Florida has one of the nation’s strictest abortion bans, barring the procedure after six weeks of pregnancy. The statute says medication for abortion must be dispensed in-person by a physician and can’t be sent by mail, which is more restrictive than other parts of the country.
There’s no indication that Florida’s regulators are asking for the information to enforce abortion bans or other policies beyond oversight of pharmacy benefits managers. But the data sought is significantly more extensive than what insurance regulators typically ask for when doing market oversight. Reviews of insurance companies’ conduct usually start with a sample of data scrubbed of identifying information.
“You want to know the actual individual’s name?” said Lee Hertz, a director at Quest Analytics Group, which consults for employers on pharmacy benefits. “That’s spooky.”
One PBM raised privacy concerns with the state in a phone call with regulators, but they were dismissed, according to someone at the company who asked not to be named discussing its dealings with the state. There are exceptions to federal health privacy laws that permit personal information to be disclosed, but the state hasn’t justified why it is asking for the data, this person said.
Photo: Photographer: George Frey/Getty Images
Topics Florida
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