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HOUSE BILL 174
57TH LEGISLATURE - STATE OF NEW MEXICO - FIRST SESSION, 2025
INTRODUCED BY
Gail Armstrong
AN ACT
RELATING TO INSURANCE; REQUIRING HEALTH INSURANCE THAT IS
PROVIDED AS PART OF THE HEALTH CARE PURCHASING ACT TO REIMBURSE
COMMUNITY-BASED PHARMACIES FOR THE FULL COST OF PRESCRIPTION
DRUGS PLUS A PROFESSIONAL DISPENSING FEE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. A new section of the Health Care Purchasing
Act is enacted to read:
"[NEW MATERIAL] COMMUNITY-BASED PHARMACY REIMBURSEMENT.--
A. Group health coverage, including any form of
self-insurance, offered, issued or renewed under the Health
Care Purchasing Act that offers a prescription drug benefit
shall reimburse community-based pharmacy providers as follows:
(1) for the ingredient cost of a prescription
drug at a value that is at least equal to the national average
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drug acquisition cost for the prescription drug at the time
that the prescription drug is administered or dispensed, or if
data for the national average drug acquisition cost is
unavailable, the wholesale acquisition cost of the prescription
drug; and
(2) a professional dispensing fee.
B. The professional dispensing fee reimbursed to
community-based pharmacy providers shall be no less than the
professional dispensing fee reimbursed to community-based
pharmacy providers for covered outpatient drugs in the medicaid
fee-for-service program.
C. For the purposes of this section:
(1) "community-based pharmacy provider" means
a pharmacy that is:
(a) open to the public for prescriptions
to be filled, regardless of the facility or practice where the
prescription was written;
(b) located in the state or near the
state border, if the border town is a primary source of
prescription drugs for medicaid recipients residing in the
border area; and
(c) not: 1) government-owned; 2)
hospital-owned; 3) owned by a corporation that owns hospitals;
4) an extension of a medical practice or special facility; 5)
owned by a corporate chain of pharmacies with stores outside of
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the state; or 6) a mail-order pharmacy;
(2) "ingredient cost" means the actual amount
paid to a community-based pharmacy provider for a prescription
drug, not including the professional dispensing fee or cost
sharing;
(3) "medicaid" means the medical assistance
program established pursuant to Title 19 of the federal Social
Security Act and regulations issued pursuant to that act;
(4) "national average drug acquisition cost"
means the national average of prices at which pharmacies
purchase a prescription drug from manufacturers or wholesalers;
and
(5) "wholesale acquisition cost" means a
manufacturer's list price for a prescription drug sold to
wholesalers in the United States, not including discounts,
rebates or reductions in price."
SECTION 2. EFFECTIVE DATE.--The effective date of the
provisions of this act is January 1, 2026.
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