Bill > S05939

This bill requires pharmacy benefit managers (PBMs) to pay participating pharmacies at least the national average drug acquisition cost (NADAC) rate, or the pharmacy's actual acquisition cost if no NADAC rate exists, plus a professional dispensing fee that matches or exceeds the fee paid under the state medical assistance program. The bill defines NADAC as a monthly survey by the Centers for Medicare and Medicaid Services (CMS) to determine average drug acquisition costs, and defines pharmacy acquisition cost rate as the actual cost a pharmacy pays to acquire drugs. For specialized medications requiring unique handling, distribution, patient teaching, or monitoring, pharmacies will be eligible for additional dispensing fees to ensure they are not operating at a loss. The bill applies to various types of drugs, including generic, brand name, biologic, and genetically produced medications, and includes provisions for pharmacies to appeal pricing disputes. Notably, the bill exempts prescription drug payments made through certain labor union-related health plans and collective bargaining agreements. The provisions will take effect on January 1, 2026, and will apply to all insurance policies and contracts issued or modified on or after that date, aiming to provide more transparent and fair compensation for pharmacies.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/S5939