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| 28 | 28 | | SENATE BILL 62 |
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| 29 | 29 | | 57 |
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| 30 | 30 | | TH LEGISLATURE |
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| 31 | 31 | | - |
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| 32 | 32 | | |
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| 33 | 33 | | STATE |
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| 34 | 34 | | |
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| 35 | 35 | | OF |
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| 36 | 36 | | |
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| 37 | 37 | | NEW |
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| 38 | 38 | | |
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| 39 | 39 | | MEXICO |
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| 40 | 40 | | |
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| 41 | 41 | | - |
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| 42 | 42 | | FIRST SESSION |
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| 43 | 43 | | , |
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| 44 | 44 | | |
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| 45 | 45 | | 2025 |
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| 46 | 46 | | INTRODUCED BY |
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| 47 | 47 | | Elizabeth "Liz" Stefanics and Elizabeth "Liz" Thomson |
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| 48 | 48 | | FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE |
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| 49 | 49 | | AN ACT |
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| 50 | 50 | | RELATING TO PHARMACEUTICAL BENEFITS; AMENDING THE PHARMACY |
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| 51 | 51 | | BENEFITS MANAGER REGULATION ACT TO RESTRICT THE TYPES OF FEES |
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| 52 | 52 | | THAT PHARMACY BENEFITS MANAGERS CAN COLLECT; DECLARING CERTAIN |
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| 53 | 53 | | ACTIONS MADE BY PHARMACY BENEFITS MANAGERS AS UNFAIR OR |
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| 54 | 54 | | DECEPTIVE TRADE PRACTICES. |
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| 55 | 55 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO: |
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| 56 | 56 | | SECTION 1. Section 59A-61-2 NMSA 1978 (being Laws 2014, |
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| 57 | 57 | | Chapter 14, Section 2, as amended) is amended to read: |
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| 58 | 58 | | "59A-61-2. DEFINITIONS.--As used in the Pharmacy Benefits |
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| 59 | 59 | | Manager Regulation Act: |
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| 60 | 60 | | A. "bona fide service fee" means a fee charged by a |
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| 61 | 61 | | pharmacy benefits manager that is: |
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| 62 | 62 | | (1) a flat dollar amount; |
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| 63 | 63 | | (2) consistent with fair market value; and |
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| 64 | 64 | | .228847.1 underscored material = new |
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| 65 | 65 | | [bracketed material] = delete |
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| 91 | 91 | | (3) solely related to the provision of |
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| 92 | 92 | | pharmacy benefits management services; |
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| 93 | 93 | | B. "conflict of interest" means a situation in |
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| 94 | 94 | | which a pharmacy benefits manager or pharmacy benefits manager |
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| 95 | 95 | | affiliate derives any kind of remuneration, other than the |
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| 96 | 96 | | collection of a bona fide service fee, from providing pharmacy |
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| 97 | 97 | | benefits management services; |
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| 98 | 98 | | [A.] C. "maximum allowable cost" means the maximum |
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| 99 | 99 | | amount that a pharmacy benefits manager will reimburse a |
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| 100 | 100 | | pharmacy for the cost of a generic drug; |
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| 101 | 101 | | [B.] D. "maximum allowable cost list" means a |
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| 102 | 102 | | searchable, electronic and internet-based listing of drugs used |
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| 103 | 103 | | by a pharmacy benefits manager setting the maximum allowable |
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| 104 | 104 | | cost on which reimbursement to a pharmacy or pharmacist is |
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| 105 | 105 | | made; |
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| 106 | 106 | | [C.] E. "obsolete" means a product that is listed |
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| 107 | 107 | | in national drug pricing compendia but is no longer available |
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| 108 | 108 | | to be dispensed based on the expiration date of the last lot |
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| 109 | 109 | | manufactured; |
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| 110 | 110 | | [D.] F. "pharmacist" means an individual licensed |
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| 111 | 111 | | as a pharmacist by the board of pharmacy; |
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| 112 | 112 | | [E.] G. "pharmacy" means a licensed place of |
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| 113 | 113 | | business where drugs are compounded or dispensed and pharmacist |
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| 114 | 114 | | services are provided; |
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| 115 | 115 | | [F.] H. "pharmacy benefits management" means a |
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| 116 | 116 | | .228847.1 |
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| 117 | 117 | | - 2 - underscored material = new |
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| 118 | 118 | | [bracketed material] = delete |
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| 144 | 144 | | service provided to or conducted by a health plan as defined in |
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| 145 | 145 | | Section 59A-16-21.1 NMSA 1978, [or ] health insurer or other |
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| 146 | 146 | | third party that involves: |
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| 147 | 147 | | (1) prescription drug claim administration; |
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| 148 | 148 | | (2) pharmacy network management; |
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| 149 | 149 | | (3) negotiation and administration of |
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| 150 | 150 | | prescription drug discounts, rebates and other benefits; |
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| 151 | 151 | | (4) design, administration or management of |
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| 152 | 152 | | prescription drug benefits; |
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| 153 | 153 | | (5) formulary management; |
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| 154 | 154 | | (6) payment of claims to pharmacies for |
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| 155 | 155 | | dispensing prescription drugs; |
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| 156 | 156 | | (7) negotiation or administration of contracts |
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| 157 | 157 | | relating to pharmacy operations or prescription benefits; or |
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| 158 | 158 | | (8) any other service determined by the |
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| 159 | 159 | | superintendent as specified by rule to be a pharmacy benefits |
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| 160 | 160 | | management activity; |
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| 161 | 161 | | [G.] I. "pharmacy benefits manager" means an entity |
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| 162 | 162 | | that provides pharmacy benefits management services; |
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| 163 | 163 | | [H.] J. "pharmacy benefits manager affiliate" means |
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| 164 | 164 | | a pharmacy or pharmacist that directly or indirectly, through |
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| 165 | 165 | | one or more intermediaries, owns or controls, is owned or |
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| 166 | 166 | | controlled by or is under common ownership or control with a |
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| 167 | 167 | | pharmacy benefits manager; |
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| 168 | 168 | | [I.] K. "pharmacy services administrative |
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| 169 | 169 | | .228847.1 |
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| 170 | 170 | | - 3 - underscored material = new |
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| 197 | 197 | | organization" means an entity that contracts with a pharmacy or |
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| 198 | 198 | | pharmacist to act as the pharmacy or pharmacist's agent with |
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| 199 | 199 | | respect to matters involving a pharmacy benefits manager or |
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| 200 | 200 | | third-party payor, including negotiating, executing or |
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| 201 | 201 | | administering contracts with the pharmacy benefits manager or |
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| 202 | 202 | | third-party payor; and |
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| 203 | 203 | | [J.] L. "superintendent" means the superintendent |
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| 204 | 204 | | of insurance." |
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| 205 | 205 | | SECTION 2. Section 59A-61-3 NMSA 1978 (being Laws 2014, |
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| 206 | 206 | | Chapter 14, Section 3, as amended) is amended to read: |
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| 207 | 207 | | "59A-61-3. LICENSURE--INITIAL APPLICATION--ANNUAL RENEWAL |
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| 208 | 208 | | REQUIRED--REVOCATION.-- |
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| 209 | 209 | | A. A person shall not operate as a pharmacy |
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| 210 | 210 | | benefits manager or provide pharmacy benefits management |
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| 211 | 211 | | services unless licensed by the superintendent in accordance |
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| 212 | 212 | | with the Pharmacy Benefits Manager Regulation Act and |
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| 213 | 213 | | applicable federal and state laws. A licensee shall renew the |
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| 214 | 214 | | licensee's pharmacy benefits manager license annually. |
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| 215 | 215 | | B. An initial application and a renewal application |
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| 216 | 216 | | for licensure as a pharmacy benefits manager shall be made on a |
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| 217 | 217 | | form and in a manner provided for by the superintendent, but at |
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| 218 | 218 | | a minimum shall require: |
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| 219 | 219 | | (1) the identity of the pharmacy benefits |
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| 220 | 220 | | manager; |
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| 221 | 221 | | (2) the name and business address of the |
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| 222 | 222 | | .228847.1 |
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| 223 | 223 | | - 4 - underscored material = new |
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| 250 | 250 | | contact person for the pharmacy benefits manager; |
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| 251 | 251 | | (3) where applicable, the federal employer |
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| 252 | 252 | | identification number for the pharmacy benefits manager; and |
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| 253 | 253 | | (4) any other information specified in rules |
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| 254 | 254 | | promulgated by the superintendent. |
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| 255 | 255 | | C. The superintendent shall enforce and promulgate |
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| 256 | 256 | | rules to implement the provisions of the Pharmacy Benefits |
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| 257 | 257 | | Manager Regulation Act and may suspend or revoke a license |
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| 258 | 258 | | issued to a pharmacy benefits manager or deny an application |
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| 259 | 259 | | for a license or renewal of a license if: |
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| 260 | 260 | | (1) the pharmacy benefits manager is operating |
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| 261 | 261 | | in contravention of its application; |
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| 262 | 262 | | (2) the pharmacy benefits manager has failed |
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| 263 | 263 | | to continuously meet or comply with the requirements for |
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| 264 | 264 | | issuance or maintenance of a license; [or ] |
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| 265 | 265 | | (3) the pharmacy benefits manager has a |
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| 266 | 266 | | conflict of interest; or |
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| 267 | 267 | | [(3)] (4) the pharmacy benefits manager has |
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| 268 | 268 | | failed to comply with applicable state or federal laws or |
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| 269 | 269 | | rules. |
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| 270 | 270 | | D. If the license of a pharmacy benefits manager is |
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| 271 | 271 | | revoked, the pharmacy benefits manager shall proceed, |
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| 272 | 272 | | immediately following the effective date of the order of |
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| 273 | 273 | | revocation, to conclude its affairs, notify each pharmacy in |
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| 274 | 274 | | its network and conduct no further pharmacy benefits management |
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| 275 | 275 | | .228847.1 |
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| 276 | 276 | | - 5 - underscored material = new |
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| 303 | 303 | | services in the state, except as may be essential to the |
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| 304 | 304 | | orderly conclusion of its affairs. The superintendent may |
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| 305 | 305 | | permit further operation of the pharmacy benefits manager if |
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| 306 | 306 | | the superintendent finds it to be in the best interest of |
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| 307 | 307 | | patients. A pharmacy benefits manager's failure to comply with |
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| 308 | 308 | | the superintendent's order to conclude the pharmacy benefits |
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| 309 | 309 | | manager's affairs shall constitute an unfair or deceptive trade |
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| 310 | 310 | | practice pursuant to the Unfair Practices Act. |
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| 311 | 311 | | E. A person whose pharmacy benefits manager license |
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| 312 | 312 | | has been denied, suspended or revoked may seek review of the |
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| 313 | 313 | | denial, suspension or revocation pursuant to the provisions of |
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| 314 | 314 | | Chapter 59A, Article 4 NMSA 1978. |
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| 315 | 315 | | F. Nothing in the Pharmacy Benefits Manager |
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| 316 | 316 | | Regulation Act shall be construed to authorize a pharmacy |
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| 317 | 317 | | benefits manager to transact the business of insurance." |
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| 318 | 318 | | - 6 - |
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| 319 | 319 | | .228847.1 |
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