Community Pharmacy Works for State Change
Bob Brashear worked as a pharmacist for as long as his son, Jesse, can remember. “He worked for 20 years at Fedco in Inverness. When they were bought out by Eckerd, the things he felt were important to his profession seemed to lose importance to the store. Dad and Mom started their own retail pharmacy Brashear’s Pharmacy and his commitment to patient care continued.”
Jesse remembers waiting for Dad to get off work. He would get the kids and drive to a patient’s house. “Why wasn’t my dad taking us home?” Jesse wondered, “Turned out he was helping get their pill caddy straightened out or running over a medication that they needed the same day.”
Elis Brashear, a local teenager, began working at the store under Bob before she attended University of Florida and earned her Pharmacy degree. Jesse fell in love with her while studying Political Science at FSU, and the two returned home eventually taking over the store and adding another location in Lecanto.
“This is our family doing our best to take care of our community,” Jesse says, “That is why I began getting more and more involved with statewide politics which culminated in Governor DeSantis’ Executive Order 22-164 Increasing Transparency and Accountability in the Pharmaceutical Industrial Complex on July 8, 2022, and a Florida bill to expose the financial dealings of Pharmacy Benefit Managers May 1, 2023.”
What are Pharmacy Benefit Managers?
Independent pharmacy owners have been at the forefront of raising concerns about Pharmacy Benefit Managers (PBMs) on a nationwide basis for almost a decade. PBMs have caused higher drug prices to patients through the imposition of what the industry calls “rebates” from drug manufacturers to include their products on the PBMs formulary. Patients have access to formulary drugs when using their prescription insurance.
“In any other industry these rebates would be referred to as the kickbacks they are,” Jesse shares. The higher the manufacturer sets the list price the greater the rebate that the PBM can demand from them in return. This causes higher drug prices for patients throughout Florida and the nation.
It has gotten so out of hand that independent pharmacists are often paying more for the drugs than they can sell them at, which means that either the independent must stop selling those medications or they have to sell at a loss. This spells disaster for any business. With Brashear’s multigenerational commitment to its patients, it was not a good choice.
Years of Commitment Helped to Create Legislative Reform
“For years I wrote letters, sent emails, and made phone calls to state legislators supporting legislation for PBM reform,” Jesse explained. “We hosted visits with former congressman, Daniel Webster in 2016 and 2018 to drive attention to problems caused by PBMs. In 2020 we hosted a press conference and invited Citrus County Chamber President and CEO, Josh Wooten, former Commissioner Jimmie T. Smith, and owner of G&R Pharmacy, Raj Patel, to join us in bringing attention to the issue.”
In 2022 there started to be some momentum in Florida, after years of work from so many pharmacists in the State. In July of 2022, Governor DeSantis signed an executive order to prevent PBM spread pricing, audit PBM contracts, and investigate rebates between drug manufacturers, PBMs, and clawbacks from pharmacies.
A study showed how PBMs were causing higher drug prices in Florida, but their contracts and pricing have always been secret. Now the Legislature saw that change was needed to lower drug prices.
A bill was filed that could become the most comprehensive reform bill in the nation to reduce drug prices and increase transparency in the pharmaceutical industry and Jesse Brashear, owner of Brashear’s Pharmacy in Inverness was instrumental in getting it passed.
“PBM reform was always going to be a fight and even with the push from Governor DeSantis nothing was guaranteed,” Jesse explained.
On March 20, Jesse got an email from the president of Small Business Pharmacies Aligned for Reform (SPAR), Dawn Butterfield, asking if he could go to Tallahassee and help lobby.
“I remember sitting in my office and checking my calendar. With nothing pressing, this felt like it was the year,” Jesse recalled.
Rep. Massullo had signed up as a co-sponsor of the bill the day before he arrived, so Jesse began by stopping by his Tallahassee office to thank him for his support.
He visited other legislative offices that first day, asking for support of PBM reform, but drove home thinking he hadn’t accomplished much. PBM reform is a massively complex issue affecting patients, pharmacies, insurance companies, drug manufacturers, and the PBMs themselves.
The Brashears go to Tallahassee
But Jesse Brashear went back. As the PBM bill was heard in Senate and House committees, he drove to Tallahassee over and over. At some point, he realized the momentum was there and it didn’t matter what was on the schedule, work or family, getting the bill passed became his priority.
“I have 3 children, Lydia, (13), Sebastian, (12), and Isaac (10). Their Spring Break and our family’s plans to travel out of state coincided with the PBM bill being heard in committee. We drove as a family and sat in House and Senate committees together for a few days while I got up to speak in support of the bill,” Jesse said.
There were industry experts that spoke in legislative committees and to individual legislators in their offices. Jesse would approach the committee and make it personal. It is about patients. It is about helping small businesses care for patients.
“I would speak from the heart and explain that I’m a second-generation pharmacy owner but that without PBM reform, I don’t think we’ll see a third generation,” Jesse told them. In several committees, he would point to his children sitting in the front row and explain that he had to encourage his children to pursue other interests outside of pharmacy in their future careers.
The bill eventually made its way through the House and Senate, passing on the last week of the legislative session.
Governor Ron DeSantis invites the Brashears to the Bill Signing
On May 1, Jesse was outside playing basketball with his son when a man called from the Governor’s office.
“He was calling from Governor DeSantis’s office and wanted to talk to me about the PBM bill and what I thought about it: what it may be lacking and how it could be improved on next year. We spoke and then he invited me to attend the bill-signing ceremony in Jupiter. I said I would and asked if my wife and kids could come. I would be speaking. So, we picked our kids up from school the next afternoon and went,” Jesse shared.
“The House bill sponsor, Rep. Linda Chaney was there, the AHCA Secretary, the Secretary of the Florida Dept of Elder Affairs, Michelle Branham, several other citizens, a Publix pharmacist, and myself stood on stage and watched the bill be signed,” Jesse shared. “I got a pen that the bill was signed with.”
Brashears is Excited to See How the Bill will Help Floridians
“I’m excited to see what impact the bill will have in reducing drug pricing when it goes into full effect on contracts starting January 1st, 2024, Jesse shares, “Our first commitment is always to our patients.”
His wife, Elis, is one of the pharmacists in their stores. “Recently, Elis had a patient who needed two medications from her pharmacy. One was $100 and the other $17. When she rang the sale up, the patient said they only had $100. She had them sit down and went to work. By the time she was done, both medications were delivered for $100. That is one of many examples of how we employ a business philosophy of saying, “yes” to our customers,” Jesse explains.
A pharmacy’s first priority is to its patients. He is hoping that this bill will lower drug prices for all Floridians because the system is broken and he hopes to help fix it. When asked if he would expend so much effort to get involved in the political process again, he smiles and says, “I plan to go back next year because the bill needs improving. There are things we can do better.”