Bill > SB14

This bill aims to regulate pharmacy benefits managers (PBMs) in New Mexico. It defines key terms like "health benefits plan" and "insured," and imposes new requirements on PBMs, including: - Requiring PBMs to be licensed and obtain annual license renewals from the Superintendent of Insurance. - Setting standards for how PBMs can determine maximum allowable costs for generic drugs and requiring an appeals process for pharmacies. - Prohibiting certain PBM practices, such as requiring the use of specific pharmacies, charging different cost-sharing amounts at non-affiliated pharmacies, and retroactively denying or reducing claims without certain justifications. - Mandating transparency, including requiring PBMs to provide information to plan sponsors and regulators about rebates, fees, and the impact on premiums. - Establishing a fiduciary duty for PBMs acting on behalf of insurers. - Restricting patient cost-sharing, including requiring that rebates be applied to reduce patients' out-of-pocket costs. - Requiring PBMs to cover all medically necessary drugs on formularies. - Prohibiting restrictions on pharmacy network participation based on accreditation standards. The bill also appropriates $500,000 to the Office of Superintendent of Insurance to hire staff to regulate and enforce the PBM requirements.

Budget and Finance

https://www.nmlegis.gov/Legislation/Legislation?chamber=S&legtype=B&legno=14&year=23