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SENATE BILL 62
57
TH LEGISLATURE
-
STATE
OF
NEW
MEXICO
-
FIRST SESSION
,
2025
INTRODUCED BY
Elizabeth "Liz" Stefanics and Elizabeth "Liz" Thomson
FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE
AN ACT
RELATING TO PHARMACEUTICAL BENEFITS; AMENDING THE PHARMACY
BENEFITS MANAGER REGULATION ACT TO RESTRICT THE TYPES OF FEES
THAT PHARMACY BENEFITS MANAGERS CAN COLLECT; DECLARING CERTAIN
ACTIONS MADE BY PHARMACY BENEFITS MANAGERS AS UNFAIR OR
DECEPTIVE TRADE PRACTICES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. Section 59A-61-2 NMSA 1978 (being Laws 2014,
Chapter 14, Section 2, as amended) is amended to read:
"59A-61-2. DEFINITIONS.--As used in the Pharmacy Benefits
Manager Regulation Act:
A. "bona fide service fee" means a fee charged by a
pharmacy benefits manager that is:
(1) a flat dollar amount;
(2) consistent with fair market value; and
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(3) solely related to the provision of
pharmacy benefits management services;
B. "conflict of interest" means a situation in
which a pharmacy benefits manager or pharmacy benefits manager
affiliate derives any kind of remuneration, other than the
collection of a bona fide service fee, from providing pharmacy
benefits management services;
[A.] C. "maximum allowable cost" means the maximum
amount that a pharmacy benefits manager will reimburse a
pharmacy for the cost of a generic drug;
[B.] D. "maximum allowable cost list" means a
searchable, electronic and internet-based listing of drugs used
by a pharmacy benefits manager setting the maximum allowable
cost on which reimbursement to a pharmacy or pharmacist is
made;
[C.] E. "obsolete" means a product that is listed
in national drug pricing compendia but is no longer available
to be dispensed based on the expiration date of the last lot
manufactured;
[D.] F. "pharmacist" means an individual licensed
as a pharmacist by the board of pharmacy;
[E.] G. "pharmacy" means a licensed place of
business where drugs are compounded or dispensed and pharmacist
services are provided;
[F.] H. "pharmacy benefits management" means a
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service provided to or conducted by a health plan as defined in
Section 59A-16-21.1 NMSA 1978, [or ] health insurer or other
third party that involves:
(1) prescription drug claim administration;
(2) pharmacy network management;
(3) negotiation and administration of
prescription drug discounts, rebates and other benefits;
(4) design, administration or management of
prescription drug benefits;
(5) formulary management;
(6) payment of claims to pharmacies for
dispensing prescription drugs;
(7) negotiation or administration of contracts
relating to pharmacy operations or prescription benefits; or
(8) any other service determined by the
superintendent as specified by rule to be a pharmacy benefits
management activity;
[G.] I. "pharmacy benefits manager" means an entity
that provides pharmacy benefits management services;
[H.] J. "pharmacy benefits manager affiliate" means
a pharmacy or pharmacist that directly or indirectly, through
one or more intermediaries, owns or controls, is owned or
controlled by or is under common ownership or control with a
pharmacy benefits manager;
[I.] K. "pharmacy services administrative
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organization" means an entity that contracts with a pharmacy or
pharmacist to act as the pharmacy or pharmacist's agent with
respect to matters involving a pharmacy benefits manager or
third-party payor, including negotiating, executing or
administering contracts with the pharmacy benefits manager or
third-party payor; and
[J.] L. "superintendent" means the superintendent
of insurance."
SECTION 2. Section 59A-61-3 NMSA 1978 (being Laws 2014,
Chapter 14, Section 3, as amended) is amended to read:
"59A-61-3. LICENSURE--INITIAL APPLICATION--ANNUAL RENEWAL
REQUIRED--REVOCATION.--
A. A person shall not operate as a pharmacy
benefits manager or provide pharmacy benefits management
services unless licensed by the superintendent in accordance
with the Pharmacy Benefits Manager Regulation Act and
applicable federal and state laws. A licensee shall renew the
licensee's pharmacy benefits manager license annually.
B. An initial application and a renewal application
for licensure as a pharmacy benefits manager shall be made on a
form and in a manner provided for by the superintendent, but at
a minimum shall require:
(1) the identity of the pharmacy benefits
manager;
(2) the name and business address of the
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contact person for the pharmacy benefits manager;
(3) where applicable, the federal employer
identification number for the pharmacy benefits manager; and
(4) any other information specified in rules
promulgated by the superintendent.
C. The superintendent shall enforce and promulgate
rules to implement the provisions of the Pharmacy Benefits
Manager Regulation Act and may suspend or revoke a license
issued to a pharmacy benefits manager or deny an application
for a license or renewal of a license if:
(1) the pharmacy benefits manager is operating
in contravention of its application;
(2) the pharmacy benefits manager has failed
to continuously meet or comply with the requirements for
issuance or maintenance of a license; [or ]
(3) the pharmacy benefits manager has a
conflict of interest; or
[(3)] (4) the pharmacy benefits manager has
failed to comply with applicable state or federal laws or
rules.
D. If the license of a pharmacy benefits manager is
revoked, the pharmacy benefits manager shall proceed,
immediately following the effective date of the order of
revocation, to conclude its affairs, notify each pharmacy in
its network and conduct no further pharmacy benefits management
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services in the state, except as may be essential to the
orderly conclusion of its affairs. The superintendent may
permit further operation of the pharmacy benefits manager if
the superintendent finds it to be in the best interest of
patients. A pharmacy benefits manager's failure to comply with
the superintendent's order to conclude the pharmacy benefits
manager's affairs shall constitute an unfair or deceptive trade
practice pursuant to the Unfair Practices Act.
E. A person whose pharmacy benefits manager license
has been denied, suspended or revoked may seek review of the
denial, suspension or revocation pursuant to the provisions of
Chapter 59A, Article 4 NMSA 1978.
F. Nothing in the Pharmacy Benefits Manager
Regulation Act shall be construed to authorize a pharmacy
benefits manager to transact the business of insurance."
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