Senate Bill S6297

2019-2020 Legislative Session

Relates to reducing pharmacy benefit manager costs

download bill text pdf

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee


  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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2019-S6297 (ACTIVE) - Details

See Assembly Version of this Bill:
A8165
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Add §3114, Ins L
Versions Introduced in Other Legislative Sessions:
2021-2022: S1768, A291
2023-2024: S1888, A6352

2019-S6297 (ACTIVE) - Summary

Relates to reducing pharmacy benefit manager costs; defines "pharmacy benefit manager".

2019-S6297 (ACTIVE) - Sponsor Memo

2019-S6297 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6297
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                               June 3, 2019
                                ___________
 
 Introduced  by  Sen. SKOUFIS -- read twice and ordered printed, and when
   printed to be committed to the Committee on Rules
 
 AN ACT to amend the insurance law,  in  relation  to  reducing  pharmacy
   benefit manager costs
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. The insurance law is amended by adding a new  section  3114
 to read as follows:
   §  3114.  PHARMACY  BENEFIT  MANAGEMENT  SERVICES. (A) ANY CONTRACT OR
 OTHER ARRANGEMENT ENTERED INTO  BY  A  HEALTH  INSURER  OFFERING  HEALTH
 INSURANCE  UNDER  ARTICLE  THIRTY-TWO OR FORTY-THREE OF THIS CHAPTER FOR
 THE PROVISION AND ADMINISTRATION OF PHARMACY BENEFIT MANAGEMENT SERVICES
 SHALL BE BASED ON A PASS-THROUGH PRICING MODEL AND INCLUDE THE FOLLOWING
 REQUIREMENTS:
   (1) PAYMENT TO THE  PHARMACY  BENEFIT  MANAGER  FOR  PHARMACY  BENEFIT
 MANAGEMENT  SERVICES  SHALL  BE  LIMITED TO THE ACTUAL INGREDIENT COSTS,
 DISPENSING FEES PAID TO  PHARMACIES,  AND  AN  ADMINISTRATIVE  FEE  THAT
 COVERS THE COST OF PROVIDING PHARMACY BENEFIT MANAGEMENT SERVICES PURSU-
 ANT  TO  A  CONTRACT  DESCRIBED  IN  THIS SUBSECTION. THE DEPARTMENT MAY
 ESTABLISH A MAXIMUM ADMINISTRATIVE FEE;
   (2) THE PHARMACY  BENEFIT  MANAGER  SHALL  IDENTIFY  ALL  SOURCES  AND
 AMOUNTS  OF  INCOME,  PAYMENTS,  AND  FINANCIAL BENEFITS TO THE PHARMACY
 BENEFIT MANAGER RELATED TO THE PROVISION AND ADMINISTRATION OF  PHARMACY
 BENEFIT  MANAGEMENT  SERVICES ON BEHALF OF THE HEALTH CARE PLAN, INCLUD-
 ING, BUT NOT LIMITED TO, ANY PRICING DISCOUNTS,  REBATES  OF  ANY  KIND,
 INFLATIONARY  PAYMENTS,  CREDITS,  CLAWBACKS, FEES, GRANTS, CHARGEBACKS,
 REIMBURSEMENTS, OR OTHER BENEFITS AND SHALL ENSURE THAT ANY  PORTION  OF
 SUCH  INCOME,  PAYMENTS, AND FINANCIAL BENEFITS IS PASSED THROUGH TO THE
 HEALTH CARE PLAN IN FULL TO REDUCE THE REPORTABLE INGREDIENT COST;
   (3) THE PHARMACY BENEFIT MANAGER SHALL FULLY DISCLOSE TO  THE  DEPART-
 MENT  AND TO THE HEALTH CARE PLAN THE SOURCES AND AMOUNTS OF ALL INCOME,
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

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