Bill > A01722

This bill introduces new regulations for Pharmacy Benefit Managers (PBMs), which are entities that manage prescription drug benefits for health insurers. The bill requires PBMs to operate under a "pass-through pricing model" where they can only charge limited administrative fees on top of actual drug ingredient costs and pharmacy dispensing fees. PBMs must fully disclose all sources of income, payments, and financial benefits related to their services, including rebates, discounts, and credits, and pass these through to the health care plan to reduce overall drug costs. The bill prohibits "spread pricing," where PBMs charge health plans more than they pay pharmacies, and mandates that any such excess amounts be remitted quarterly. PBMs must make their payment models transparent to health care plans and the department, and may be required to make changes if directed. Any premium changes resulting from these new contract requirements must be approved by the department. The legislation aims to increase transparency and reduce hidden costs in pharmacy benefit management, ultimately seeking to lower prescription drug expenses for consumers and health care plans.

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https://www.nysenate.gov/legislation/bills/2025/A1722