Bill > A09045

This bill amends the New York public health law to regulate pharmacy benefit managers (PBMs), which are intermediaries that manage prescription drug benefits for health insurance plans. The bill requires PBMs to ensure that pharmacies are reimbursed fairly by establishing two key provisions: first, if a pharmacy challenges a reimbursement rate and an appeal is denied, the PBM must identify a therapeutically equivalent drug that can be purchased at or below the maximum allowable cost, and if no such drug is available, the PBM must adjust its pricing methodology and allow the pharmacy to reverse and rebill claims; second, PBMs are prohibited from reimbursing a pharmacy or pharmacist an amount less than what they would reimburse their own affiliated pharmacies for the same services, with reimbursement calculated on a per-unit basis using the same generic product identifier. The goal of this legislation is to prevent PBMs from engaging in practices that could potentially underpay pharmacies and create financial challenges for local drug stores. The bill will take effect 90 days after becoming law.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/A9045