New Mexico 2025 Regular Session

New Mexico House Bill HB174 Compare Versions

Version 1 (Old)

Version 2 (New)

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1		-	~~HB 174~~
2		-	~~Page 1~~
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	28	+	HOUSE BILL 174
	29	+	57TH LEGISLATURE - STATE OF NEW MEXICO - FIRST SESSION, 2025
	30	+	INTRODUCED BY
	31	+	Gail Armstrong
28	32		AN ACT
29	33		RELATING TO INSURANCE; REQUIRING HEALTH INSURANCE THAT IS
30		-	PROVIDED AS PART OF THE HEALTH CARE PURCHASING ACT TO
31		-	~~REIMBURSE~~ COMMUNITY-BASED PHARMACIES FOR THE FULL COST OF
32		-	~~PRESCRIPTION~~ DRUGS PLUS A PROFESSIONAL DISPENSING FEE.
	34	+	PROVIDED AS PART OF THE HEALTH CARE PURCHASING ACT TO REIMBURSE
	35	+	COMMUNITY-BASED PHARMACIES FOR THE FULL COST OF PRESCRIPTION
	36	+	DRUGS PLUS A PROFESSIONAL DISPENSING FEE.
33	37		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
34	38		SECTION 1. A new section of the Health Care Purchasing
35	39		Act is enacted to read:
36		-	"COMMUNITY-BASED PHARMACY REIMBURSEMENT.--
	40	+	"[NEW MATERIAL] COMMUNITY-BASED PHARMACY REIMBURSEMENT.--
37	41		A. Group health coverage, including any form of
38	42		self-insurance, offered, issued or renewed under the Health
39	43		Care Purchasing Act that offers a prescription drug benefit
40		-	shall reimburse community-based pharmacy providers as
41		-	follows:
42		-	(1) for the ingredient cost of a
43		-	prescription drug at a value that is at least equal to the
44		-	national average drug acquisition cost for the prescription
45		-	drug at the time that the prescription drug is administered
46		-	or dispensed, or if data for the national average drug
47		-	acquisition cost is unavailable, the wholesale acquisition
48		-	cost of the prescription drug; and
49		-	(2) a professional dispensing fee.
50		-	B. The professional dispensing fee reimbursed to
51		-	community-based pharmacy providers shall be no less than the HB 174
52		-	Page 2
	44	+	shall reimburse community-based pharmacy providers as follows:
	45	+	(1) for the ingredient cost of a prescription
	46	+	drug at a value that is at least equal to the national average
	47	+	.228854.1 underscored material = new
	48	+	[bracketed material] = delete
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	74	+	drug acquisition cost for the prescription drug at the time
	75	+	that the prescription drug is administered or dispensed, or if
	76	+	data for the national average drug acquisition cost is
	77	+	unavailable, the wholesale acquisition cost of the prescription
	78	+	drug; and
	79	+	(2) a professional dispensing fee.
	80	+	B. The professional dispensing fee reimbursed to
	81	+	community-based pharmacy providers shall be no less than the
78	82		professional dispensing fee reimbursed to community-based
79		-	pharmacy providers for covered outpatient drugs in the
80		-	~~medicaid~~ fee-for-service program.
	83	+	pharmacy providers for covered outpatient drugs in the medicaid
	84	+	fee-for-service program.
81	85		C. For the purposes of this section:
82		-	(1) "community-based pharmacy provider"
83		-	~~means~~ a pharmacy that is:
84		-	(a) open to the public for
85		-	~~prescriptions~~ to be filled, regardless of the facility or
86		-	~~practice where the~~ prescription was written;
	86	+	(1) "community-based pharmacy provider" means
	87	+	a pharmacy that is:
	88	+	(a) open to the public for prescriptions
	89	+	to be filled, regardless of the facility or practice where the
	90	+	prescription was written;
87	91		(b) located in the state or near the
88	92		state border, if the border town is a primary source of
89	93		prescription drugs for medicaid recipients residing in the
90	94		border area; and
91	95		(c) not: 1) government-owned; 2)
92		-	hospital-owned; 3) owned by a corporation that owns
93		-	hospitals; 4) an extension of a medical practice or special
94		-	facility; 5) owned by a corporate chain of pharmacies with
95		-	stores outside of the state; or 6) a mail-order pharmacy;
96		-	(2) "ingredient cost" means the actual
97		-	amount paid to a community-based pharmacy provider for a
98		-	prescription drug, not including the professional dispensing
99		-	fee or cost sharing;
100		-	(3) "medicaid" means the medical assistance
101		-	program established pursuant to Title 19 of the federal
102		-	Social Security Act and regulations issued pursuant to that HB 174
103		-	Page 3
	96	+	hospital-owned; 3) owned by a corporation that owns hospitals;
	97	+	4) an extension of a medical practice or special facility; 5)
	98	+	owned by a corporate chain of pharmacies with stores outside of
	99	+	.228854.1
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129		-	act;
	127	+	the state; or 6) a mail-order pharmacy;
	128	+	(2) "ingredient cost" means the actual amount
	129	+	paid to a community-based pharmacy provider for a prescription
	130	+	drug, not including the professional dispensing fee or cost
	131	+	sharing;
	132	+	(3) "medicaid" means the medical assistance
	133	+	program established pursuant to Title 19 of the federal Social
	134	+	Security Act and regulations issued pursuant to that act;
130	135		(4) "national average drug acquisition cost"
131	136		means the national average of prices at which pharmacies
132		-	purchase a prescription drug from manufacturers or
133		-	~~wholesalers;~~ and
	137	+	purchase a prescription drug from manufacturers or wholesalers;
	138	+	and
134	139		(5) "wholesale acquisition cost" means a
135	140		manufacturer's list price for a prescription drug sold to
136	141		wholesalers in the United States, not including discounts,
137	142		rebates or reductions in price."
138	143		SECTION 2. EFFECTIVE DATE.--The effective date of the
139	144		provisions of this act is January 1, 2026.
	145	+	- 3 -
	146	+	.228854.1