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Employers and benefits advisors who want detailed data from health benefits vendors are facing a new concern: increased fear that the reports will get patients or health care providers into trouble.
The Florida Office of Insurance Regulation ran into that obstacle recently when it put out a call for raw claims data, policies and procedure records from pharmacy benefit managers, to implement a PBM registration law that was adopted in 2023.
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The new law requires PBMs to go through examinations every two years.
The raw data files include patients' names, patients' birth dates, the names of the drugs prescribed, the names of the health care providers who prescribed the drugs, and identification information for the pharmacies that filled the prescriptions.
Regulators could use the files to identify patients who had received drugs that can induce abortion, young patients who had received drugs related to gender characteristics or parents who had failed to get their children the recommended vaccinations.
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Employers and their advisors want detailed data they can use to show that the employers and other health plan fiduciaries are taking their obligation to act as plan fiduciaries seriously and paying close attention to plan costs and quality.
Some PBMs have argued that providing Florida regulators with the kinds of unredacted files requested by Florida regulators would violate the patients' privacy rights and might violate state or federal privacy laws.
Florida regulators are rejecting PBMs' objections.
The office "is pleased with the emphasis expressed by certain PBMs relating to data security,' officials say in a memorandum to PBMs posted Monday.
But existing federal health privacy guidance shows that PBMs can disclose patients' protected health information to the Florida office for health oversight activities, and protected health information data "has been historically provided to state departments of insurance by covered entities for a variety of regulatory activities," officials say.
The Florida PBM reporting news could affect benefits services provider reporting proposals considered elsewhere.
Many states, and Congress, have passed, or at least considered, PBM reporting and audit participation proposals.
In some cases, policymakers are considering proposals to apply the same types of rules that apply to PBMs to other types of health care and health plan service providers, such as third-party administrators.
Drafters of legislation and regulations may have simple ways to address privacy concerns.
The drafters of one new federal reporting bill, the Pharmacy Benefit Manager Transparency Act of 2025, included a provision in their bill stating that, "in making any disclosure or report required by this act, a pharmacy benefit manager (including their affiliates, subsidiaries, and agents) shall not include any information that would identify a patient or a provider that issued a prescription."
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
