Bill > S05939

This bill requires pharmacy benefit managers (PBMs), which are companies that manage prescription drug benefits on behalf of health insurers, to pay participating pharmacies a minimum reimbursement rate for dispensed medications. Specifically, PBMs must pay pharmacies at least the National Average Drug Acquisition Cost (NADAC) rate, which is a monthly survey of retail pharmacies by the federal Centers for Medicare and Medicaid Services (CMS) to determine average acquisition costs for Medicaid-covered outpatient drugs. If a NADAC rate is not available, PBMs must pay the pharmacy's actual acquisition cost, as documented by invoices. In addition to the drug cost, PBMs must also pay a professional dispensing fee that is at least as much as the fee paid under the state's medical assistance program, and this fee must cover any additional costs associated with dispensing specialized medications that require unique handling, patient teaching, or coordination of care. The bill also mandates that PBMs establish a reasonable process for pharmacies to appeal disputes regarding drug pricing for generic, brand-name, and biologic products, and clarifies that these provisions do not apply to certain collectively bargained health plans or trust funds.

Business and Industry, Health and Social Services

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