Cost-sharing Contributions For Prescriptions
The passage of SB51 is expected to significantly influence state insurance laws by standardizing the calculations related to copayments, coinsurance, deductibles, and other financial obligations for prescription drugs. It aims to eliminate discriminatory practices against entities participating in the federal 340B Drug Pricing Program, thereby ensuring equal reimbursement rates. Furthermore, the established guidelines on rebates and discounts are designed to ease the financial burden on insured members when accessing prescribed drugs.
SB51 focuses on the calculation of cost-sharing contributions for prescription drug coverage in New Mexico. It establishes that, beginning January 1, 2024, insurers must ensure that insured individuals do not pay more than the lowest of several specified amounts for covered prescription drugs. This includes rebates from drug manufacturers being counted toward out-of-pocket costs and ensuring that various discounts and payments from third parties are fully credited at the time of the prescription claim. This legislative change is aimed at making prescription medication more affordable.
The sentiment expressed during discussions around SB51 appeared to be largely supportive among healthcare advocates and legislators who view the bill as a necessary step toward enhancing affordability and accessibility of vital medications. However, concerns were raised regarding how stringent provisions may affect providers, particularly in the context of the federal 340B program and how this may complicate pharmacy operations or reimbursement rates, indicating a level of contention among pharmacy benefit managers and insurers over the implications of the bill.
Notable points of contention surrounded the parameters defining cost-sharing calculated for prescription drugs, potential impacts on pharmacy benefits management practices, and how compliance with the 340B program might impact partner pharmacies. There is concern that the provisions of SB51 might inadvertently cause shifts in how drugs are priced or affect the availability of pharmacies willing to participate, as they would face increased audit scrutiny or reimbursement complexities.