HB 174
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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:
"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 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 HB 174
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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 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 HB 174
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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.