New Mexico 2025 Regular Session

New Mexico Senate Bill SB503 Compare Versions

Only one version of the bill is available at this time.

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28	28	SENATE BILL 503
29	29	57
30	30	TH LEGISLATURE
31	31	-
32	32
33	33	STATE
34	34
35	35	OF
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37	37	NEW
38	38
39	39	MEXICO
40	40
41	41	-
42	42	FIRST SESSION
43	43	,
44	44
45	45	2025
46	46	INTRODUCED BY
47	47	Larry R. Scott
48	48	AN ACT
49	49	RELATING TO PHARMACIES; PROHIBITING CERTAIN PHARMACY BENEFITS
50	50	MANAGER PRACTICES.
51	51	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
52	52	SECTION 1. Section 59A-61-2 NMSA 1978 (being Laws 2014,
53	53	Chapter 14, Section 2, as amended) is amended to read:
54	54	"59A-61-2. DEFINITIONS.--As used in the Pharmacy Benefits
55	55	Manager Regulation Act:
56	56	A. "maximum allowable cost" means the maximum
57	57	amount that a pharmacy benefits manager will reimburse a
58	58	pharmacy for the cost of a generic drug;
59	59	B. "maximum allowable cost list" means a
60	60	searchable, electronic and internet-based listing of drugs used
61	61	by a pharmacy benefits manager setting the maximum allowable
62	62	cost on which reimbursement to a pharmacy or pharmacist is
63	63	.228685.1 underscored material = new
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90	90	made;
91	91	C. "obsolete" means a product that is listed in
92	92	national drug pricing compendia but is no longer available to
93	93	be dispensed based on the expiration date of the last lot
94	94	manufactured;
95	95	D. "patient steering" means:
96	96	(1) a pharmacy benefits manager directing
97	97	patients to use a preferred pharmacy through mandatory mail
98	98	order requirements;
99	99	(2) a pharmacy benefits manager requiring a
100	100	patient to use a restricted network of pharmacies that only
101	101	consists of pharmacies approved by the pharmacy benefits
102	102	manager; or
103	103	(3) the use of copay differentials for
104	104	pharmacies contracted with the pharmacy benefits manager and
105	105	pharmacies that are not contracted with the pharmacy benefits
106	106	manager;
107	107	[D.] E. "pharmacist" means an individual licensed
108	108	as a pharmacist by the board of pharmacy;
109	109	[E.] F. "pharmacy" means a licensed place of
110	110	business where drugs are compounded or dispensed and pharmacist
111	111	services are provided;
112	112	[F.] G. "pharmacy benefits management" means a
113	113	service provided to or conducted by a health plan as defined in
114	114	Section 59A-16-21.1 NMSA 1978 or health insurer that involves:
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143	143	(1) prescription drug claim administration;
144	144	(2) pharmacy network management;
145	145	(3) negotiation and administration of
146	146	prescription drug discounts, rebates and other benefits;
147	147	(4) design, administration or management of
148	148	prescription drug benefits;
149	149	(5) formulary management;
150	150	(6) payment of claims to pharmacies for
151	151	dispensing prescription drugs;
152	152	(7) negotiation or administration of contracts
153	153	relating to pharmacy operations or prescription benefits; or
154	154	(8) any other service determined by the
155	155	superintendent as specified by rule to be a pharmacy benefits
156	156	management activity;
157	157	[G.] H. "pharmacy benefits manager" means an entity
158	158	that provides pharmacy benefits management services;
159	159	[H.] I. "pharmacy benefits manager affiliate" means
160	160	a pharmacy or pharmacist that directly or indirectly, through
161	161	one or more intermediaries, owns or controls, is owned or
162	162	controlled by or is under common ownership or control with a
163	163	pharmacy benefits manager;
164	164	[I.] J. "pharmacy services administrative
165	165	organization" means an entity that contracts with a pharmacy or
166	166	pharmacist to act as the pharmacy or pharmacist's agent with
167	167	respect to matters involving a pharmacy benefits manager or
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196	196	third-party payor, including negotiating, executing or
197	197	administering contracts with the pharmacy benefits manager or
198	198	third-party payor; [and ]
199	199	K. "spread pricing" means a pharmacy benefits
200	200	manager reimbursing a pharmacy for a prescription and billing
201	201	an insurer or an employer that provides health insurance at a
202	202	higher price than was reimbursed for the same prescription; and
203	203	[J.] L. "superintendent" means the superintendent
204	204	of insurance."
205	205	SECTION 2. Section 59A-61-5 NMSA 1978 (being Laws 2014,
206	206	Chapter 14, Section 5, as amended) is amended to read:
207	207	"59A-61-5. PHARMACY BENEFITS MANAGER CONTRACTS--CERTAIN
208	208	PRACTICES PROHIBITED--CERTAIN DISCLOSURES REQUIRED UPON
209	209	REQUEST.--
210	210	A. A pharmacy benefits manager shall not require
211	211	that a pharmacy participate in one contract in order to
212	212	participate in another contract.
213	213	B. A pharmacy benefits manager shall provide to a
214	214	pharmacy by electronic mail, facsimile or certified mail, at
215	215	least thirty calendar days prior to its execution, a contract
216	216	written in plain English.
217	217	C. A contract between a pharmacy benefits manager
218	218	and a pharmacy shall identify the industry standard
219	219	reimbursement practice that the pharmacy benefits manager will
220	220	use to determine a reimbursement amount, unless the contract is
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249	249	modified in writing to specify another industry standard
250	250	practice.
251	251	D. The provisions of the Pharmacy Benefits Manager
252	252	Regulation Act shall not be waived, voided or nullified by
253	253	contract.
254	254	E. A pharmacy benefits manager shall not:
255	255	(1) cause or knowingly permit the use of any
256	256	advertisement, promotion, solicitation, representation,
257	257	proposal or offer that is untrue, deceptive or misleading;
258	258	(2) require pharmacy validation and
259	259	revalidation standards inconsistent with, more stringent than
260	260	or in addition to federal and state requirements for licensure
261	261	and operation as a pharmacy in this state;
262	262	(3) prohibit a pharmacy or pharmacist from:
263	263	(a) mailing or delivering drugs to a
264	264	patient as an ancillary service;
265	265	(b) providing a patient information
266	266	regarding the patient's total cost for pharmacist services for
267	267	a prescription drug; or
268	268	(c) discussing information regarding the
269	269	total cost for pharmacist services for a prescription drug or
270	270	from selling a more affordable alternative to the insured if a
271	271	more affordable alternative is available;
272	272	(4) require or prefer a generic drug over its
273	273	generic therapeutic equivalent;
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302	302	(5) prohibit, restrict or limit disclosure of
303	303	information by a pharmacist or pharmacy to the superintendent;
304	304	[or]
305	305	(6) prohibit, restrict or limit pharmacies or
306	306	pharmacists from providing to state or federal government
307	307	officials general information for public policy purposes;
308	308	(7) conduct or participate in patient
309	309	steering; or
310	310	(8) conduct or participate in spread pricing .
311	311	F. A pharmacy benefits manager or health benefit
312	312	plan shall not impose a fee on a pharmacy for scores or metrics
313	313	or both scores and metrics. Nothing in this subsection
314	314	prohibits a pharmacy benefits manager or health benefit plan
315	315	from offering incentives to a pharmacy based on a score or
316	316	metric; provided that the incentive is equally available to all
317	317	in-network pharmacies.
318	318	G. A clerical or recordkeeping error identified
319	319	during an audit of a pharmacy conducted by a pharmacy benefits
320	320	manager, such as a typographical error, scrivener's error,
321	321	omission or computer error, shall not, in and of itself,
322	322	constitute fraud or intentional misrepresentation and shall not
323	323	be the basis of a recoupment unless the error results in an
324	324	actual overpayment to the pharmacy or the wrong medication
325	325	being dispensed to the patient.
326	326	[G.] H. Within seven business days of a request by
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355	355	the superintendent or a contracted pharmacy or pharmacist, a
356	356	pharmacy benefits manager or pharmacy services administrative
357	357	organization shall provide as appropriate:
358	358	(1) a contract;
359	359	(2) an agreement;
360	360	(3) a claim appeal document;
361	361	(4) a disputed claim transaction document or
362	362	price list; or
363	363	(5) any other information specified by law.
364	364	[H.] I. In a time and manner required by rules
365	365	promulgated by the superintendent, a pharmacy benefits manager
366	366	shall issue to the superintendent a network adequacy report
367	367	describing the pharmacy benefits manager network and the
368	368	pharmacy benefits manager network's accessibility to insureds
369	369	statewide.
370	370	[I.] J. Pursuant to the provisions of Section
371	371	59A-4-3 NMSA 1978, the superintendent, or the superintendent's
372	372	designee, may examine the books, documents, policies,
373	373	procedures and records of a pharmacy benefits manager to
374	374	determine compliance with applicable law. The pharmacy
375	375	benefits manager shall pay the costs of the examination. At
376	376	the request of a person who provides information in response to
377	377	a complaint, investigation or examination, the superintendent
378	378	may deem the information confidential."
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