Bill > A5531

Introduced Session

This bill establishes the "Equitable Drug Pricing and Patient Accesses Act." The bill provides that the reimbursement rate for prescription drug services paid to a pharmacy providing prescription drug services to a beneficiary of the Medicaid program, whether such services are provided in the Medicaid fee-for-service delivery system or through the Medicaid managed care delivery system, will be no less than the national average drug acquisition cost of the drug plus a Medicaid fee-for-service professional dispensing fee of $10.92. The bill provides that each Medicaid managed care contract executed in this State will include pharmacy choice as a required benefit for any enrollee as outlined under the bill. To ensure that enrollees have access to a competitive selection of providers, each Medicaid managed care organization will permit the enrollee to choose any qualified pharmacy provided that the qualified pharmacy is a contracting provider and provide that no pharmacy will be denied the right to participate as a contracting provider, under the same terms and conditions currently applicable to all other contracting pharmacies, provided that the pharmacy accepts the terms and conditions of the Medicaid managed care contract. The bill requires the State Auditor to perform an audit of pharmacy pricing practices within the Medicaid program to determine the amount of savings the State should accrue from all pharmacies as a result of the provisions of the bill. In conducting this audit, the State Auditor will audit the flow of funds in the State's Medicaid program from managed care organizations to pharmacy benefit managers to pharmacies. In recent years, drug pricing has escalated at unprecedented rates. Restrictive practices that segregate certain drug types and disadvantage patients' choice and access are contributing factors, particularly in Medicaid programs. According to evaluation data found in the Governor's Budget Recommendations, total Medicaid prescription drug spending increased by approximately $700 million, or 3.3 percent, from $2.1 billion in FY 2019 to $2.8 billion in FY 2024. It is the sponsor's belief that ensuring that Medicaid establishes the Equitable Drug Pricing and Patient Access Act will provide greater transparency and cost management within the program to reduce waste and cost increases.

AI Summary

Committee Categories

Margie Donlon (D)*,  Yvonne Lopez (D)*,  Luanne Peterpaul (D)*,  Joe Danielsen (D),  Balvir Singh (D), 

Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 04/10/2025)

Official Document