Bill > S06161

This bill aims to regulate pharmacy benefit managers (PBMs), which are entities that manage prescription drug benefits for health insurers, by introducing new requirements for their contracts and operations. The legislation mandates that PBM contracts with health insurers must use a pass-through pricing model, where PBMs can only charge for actual ingredient costs, dispensing fees, and a limited administrative fee. 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 prescription costs. The bill prohibits spread pricing, which occurs when PBMs charge health plans more than they pay pharmacies, and requires PBMs to remit any excess charges quarterly. Additionally, PBMs must make their administrative fee payment models available to health care plans and the department, and any premium changes resulting from these contracts must be approved by the department. The legislation defines a pharmacy benefit manager as an entity that contracts with pharmacies on behalf of health plans, insurers, or other third-party payors to provide pharmacy benefit services, with the goal of increasing transparency and reducing prescription drug costs for consumers.

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https://www.nysenate.gov/legislation/bills/2025/S6161