Requires a pharmacy benefit manager to pay a participating pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under the state medical assistance program.
Impact
If enacted, S05939 would significantly alter the landscape of pharmacy reimbursements by changing state law concerning the pricing strategies employed by PBMs. By enforcing these minimum payment standards, the bill intends to alleviate the financial strain on pharmacies, thereby promoting their viability and sustainability. This is particularly crucial for independent pharmacies that may struggle under the current variable pricing structures imposed by PBMs. The new reimbursement requirements are expected to positively impact pharmacy operations and patient access to medications.
Summary
Bill S05939 aims to regulate the payment practices of pharmacy benefit managers (PBMs) towards participating pharmacies. The bill mandates that PBMs must pay these pharmacies at least the national average drug acquisition cost (NADAC) or the pharmacy acquisition cost rate if NADAC is unavailable. Additionally, it incorporates a professional dispensing fee that meets or exceeds the one established under the state medical assistance program. This legislation focuses on enhancing financial transparency and ensuring pharmacies are compensated fairly for the medications they dispense.
Contention
Notable points of contention around S05939 revolve around the potential impacts on PBMs and the broader healthcare market. Supporters argue that the bill will protect pharmacies from unjustly low reimbursements and ensure patients continue to have access to affordable medications. However, critics raise concerns that such regulations could lead to increased costs for health plans, potentially resulting in higher premiums for consumers. Moreover, there are apprehensions that PBMs might respond by increasing their administrative fees, which could counteract the intended benefits of the legislation.
Same As
Requires a pharmacy benefit manager to pay a participating pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under the state medical assistance program.
Requires a pharmacy benefit manager to pay an in-network pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under the state medical assistance program.
Requires a pharmacy benefit manager to pay an in-network pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under the state medical assistance program.
Relates to pharmacy services provided by managed care providers; requires pharmacy benefit managers and managed care providers to reimburse retail pharmacies for each outpatient drug, at the National Average Drug Acquisition Cost (NADAC); repeals related provisions.
Relates to pharmacy services provided by managed care providers; requires pharmacy benefit managers and managed care providers to reimburse retail pharmacies for each outpatient drug, at the National Average Drug Acquisition Cost (NADAC); repeals related provisions.
Requires Medicaid managed care plans to reimburse retail pharmacies in an amount equal to the fee-for-service rate; allows retail pharmacies the opportunity to participate in another provider's network under the medical assistance program; prohibits pharmacy benefit managers from limiting an individual's option to receive medications from non-mail order pharmacies.
Requires Medicaid managed care plans to reimburse retail pharmacies in an amount equal to the fee-for-service rate; allows retail pharmacies the opportunity to participate in another provider's network under the medical assistance program; prohibits pharmacy benefit managers from limiting an individual's option to receive medications from non-mail order pharmacies.
Requires a personal use pharmaceutical disposal system be provided to the ultimate user at the time of dispensing a prescribed controlled substance; requires county health departments to provide such disposal systems at no cost to pharmacies.
A bill for an act relating to pharmacy benefits managers, pharmacies, prescription drugs, and pharmacy services administrative organizations, and including applicability provisions. (Formerly SSB 1074.) Effective date: 07/01/2025. Applicability date: 07/01/2025.