Requires a pharmacy benefit manager to pay a participating pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under the state medical assistance program.
Impact
If enacted, this bill would substantially impact the financial interactions between pharmacies and PBMs, establishing minimum payment standards that could enhance pharmacies' financial stability. The stipulation that pharmacies cannot be compensated below their acquisition costs is crucial in preventing underpayment practices, potentially leading to improved access to medications for patients as pharmacies may be more inclined to ensure adequate stock if they are assured fair profits on prescription drugs. Additionally, the bill encompasses provisions for the regulation of the pharmacy benefit process and appeals regarding drug pricing disputes.
Summary
Bill A05882 aims to amend certain provisions of the public health law and the insurance law concerning the payments that pharmacy benefit managers (PBMs) must make to participating pharmacies. The bill primarily focuses on ensuring that PBMs pay pharmacies no less than the national average drug acquisition cost (NADAC) rate or the pharmacy acquisition cost rate, plus a professional dispensing fee that reflects the minimum professional dispensing fee under the state medical assistance program. This framework is designed to improve reimbursement practices for pharmacies and ensure fair compensation for dispensing medications.
Contention
Among the notable points of discussion and potential contention surrounding A05882 are concerns related to the regulatory burdens it may impose on PBMs. Proponents of the bill argue that it will promote transparency and equitable payment structures within the pharmaceutical supply chain. However, critics may contend that these regulations could result in increased operational costs for PBMs, which could inadvertently lead to higher drug prices for consumers. The balance between ensuring fair pharmacy reimbursement and maintaining manageable costs for PBMs and consequently for consumers remains a critical aspect of the debate surrounding this legislation.
Same As
Requires a pharmacy benefit manager to pay a participating pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under the state medical assistance program.
Requires a pharmacy benefit manager to pay an in-network pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under the state medical assistance program.
Requires a pharmacy benefit manager to pay an in-network pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under the state medical assistance program.
Relates to pharmacy services provided by managed care providers; requires pharmacy benefit managers and managed care providers to reimburse retail pharmacies for each outpatient drug, at the National Average Drug Acquisition Cost (NADAC); repeals related provisions.
Relates to pharmacy services provided by managed care providers; requires pharmacy benefit managers and managed care providers to reimburse retail pharmacies for each outpatient drug, at the National Average Drug Acquisition Cost (NADAC); repeals related provisions.
Requires Medicaid managed care plans to reimburse retail pharmacies in an amount equal to the fee-for-service rate; allows retail pharmacies the opportunity to participate in another provider's network under the medical assistance program; prohibits pharmacy benefit managers from limiting an individual's option to receive medications from non-mail order pharmacies.
Requires Medicaid managed care plans to reimburse retail pharmacies in an amount equal to the fee-for-service rate; allows retail pharmacies the opportunity to participate in another provider's network under the medical assistance program; prohibits pharmacy benefit managers from limiting an individual's option to receive medications from non-mail order pharmacies.
Requires a personal use pharmaceutical disposal system be provided to the ultimate user at the time of dispensing a prescribed controlled substance; requires county health departments to provide such disposal systems at no cost to pharmacies.
A bill for an act relating to pharmacy benefits managers, pharmacies, prescription drugs, and pharmacy services administrative organizations, and including applicability provisions. (Formerly SSB 1074.) Effective date: 07/01/2025. Applicability date: 07/01/2025.