Bill > A07357

This bill expands pharmacy benefit management (PBM) services to include the management and administration of durable medical equipment (DME) benefits. The bill defines durable medical equipment as devices and equipment ordered by a practitioner for a specific medical condition that can withstand repeated use, are primarily used for medical purposes, are not typically useful without an illness or injury, are not usually customized for a specific individual, and include medical/surgical supplies, orthotic appliances, and orthopedic footwear. The legislation modifies existing laws to incorporate DME into various provisions related to PBMs, including audit procedures, network contracting, cost-sharing information, and penalty provisions. Specifically, the bill updates definitions and requirements across multiple sections of public health and insurance law to ensure that DME providers receive similar protections and are subject to similar regulations as pharmacies when interacting with pharmacy benefit managers. The changes aim to create more transparency, fairness, and consistency in how PBMs manage and process claims for both prescription drugs and durable medical equipment, ultimately protecting the interests of healthcare providers and patients.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/A7357