Assembly Bill A10107

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10107
 
                           I N  A S S E M B L Y
 
                                May 3, 2024
                                ___________
 
 Introduced by M. of A. KELLES -- read once and referred to the Committee
   on Health
 
 AN  ACT  to  amend  the  public health law, in relation to reimbursement
   rates of pharmacy benefit managers
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Paragraph  (e)  of  subdivision 4 of section 280-a of the
 public health law, as added by chapter 828  of  the  laws  of  2021,  is
 amended and a new subdivision 4-a is added to read as follows:
   (e)  (I)  if  an  appeal is denied, the pharmacy benefit manager shall
 identify the national drug code of a therapeutically equivalent drug, as
 determined by the federal Food and Drug Administration, that  is  avail-
 able  for  purchase  by pharmacies in this state from wholesalers regis-
 tered pursuant to subdivision four of section sixty-eight hundred  eight
 of  the  education  law  THAT  THE  PHARMACIST OR PHARMACY PURCHASES THE
 MAJORITY OF PRESCRIPTION DRUGS FOR RESALE FROM at a price which is equal
 to or less than the maximum allowable cost OR OTHER REIMBURSEMENT  PRIC-
 ING  METHODOLOGY USED BY THE PHARMACY BENEFITS MANAGER TO DETERMINE COST
 for that drug as determined by the pharmacy benefit manager.
   (II) IF THE NATIONAL DRUG CODE NUMBER  PROVIDED BY THE PHARMACY  BENE-
 FIT  MANAGER IS NOT  AVAILABLE BELOW THE PHARMACY ACQUISITION COST  FROM
 THE PHARMACEUTICAL WHOLESALER  FROM  WHOM  THE  PHARMACY  OR  PHARMACIST
 PURCHASES  THE MAJORITY OF PRESCRIPTION DRUGS FOR RESALE, THEN THE PHAR-
 MACY BENEFIT MANAGER SHALL ADJUST THE MAXIMUM ALLOWABLE  COST  OR  OTHER
 PRICING  METHODOLOGY  USED BY THE PHARMACY BENEFITS MANAGER TO DETERMINE
 COST ABOVE THE CHALLENGING  PHARMACY'S  PHARMACY  ACQUISITION  COST  AND
 PERMIT  THE  PHARMACY  TO  REVERSE AND REBILL EACH CLAIM AFFECTED BY THE
 INABILITY TO PROCURE THE DRUG AT A COST THAT IS EQUAL TO  OR  LESS  THAN
 THE PREVIOUSLY CHALLENGED MAXIMUM ALLOWABLE COST.
   4-A. REIMBURSEMENT. (A) A PHARMACY BENEFIT MANAGER SHALL NOT REIMBURSE
 A  PHARMACY  OR  PHARMACIST IN THIS STATE AN AMOUNT LESS THAN THE AMOUNT
 THAT THE PHARMACY BENEFIT MANAGER REIMBURSES A PHARMACY BENEFIT  MANAGER
 AFFILIATE FOR PROVIDING THE SAME PHARMACIST SERVICES.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD05319-02-3
              

 A. 10107                            2
 
   (B)    THE AMOUNT SHALL BE CALCULATED ON A PER UNIT BASIS BASED ON THE
 SAME GENERIC PRODUCT IDENTIFIED OR GENERIC CODE NUMBER.
   §  2.  This  act shall take effect on the ninetieth day after it shall
 have become a law.