S T A T E O F N E W Y O R K
________________________________________________________________________
9570
I N S E N A T E
May 16, 2024
___________
Introduced by Sen. BRESLIN -- read twice and ordered printed, and when
printed to be committed to the Committee on Health
AN ACT to amend the public health law, in relation to payments by phar-
macy benefit managers to in-network pharmacies
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subdivision 1 of section 280-a of the public health law is
amended by adding two new paragraphs (j) and (k) read as follows:
(J) "PHARMACY ACQUISITION COST RATE" MEANS THE COST PAID BY AN IN-NET-
WORK PHARMACY TO ACQUIRE GENERIC, BRAND NAME DRUGS OR BIOLOGIC PRODUCTS
PURSUANT TO COST INVOICES FROM A MANUFACTURER OR A WHOLESALER.
(K) "NATIONAL AVERAGE DRUG ACQUISITION COST" MEANS THE MONTHLY SURVEY
OF RETAIL PHARMACIES CONDUCTED BY THE FEDERAL CENTERS FOR MEDICARE AND
MEDICAID SERVICES (CMS) TO DETERMINE AVERAGE ACQUISITION COST FOR MEDI-
CAID COVERED OUTPATIENT DRUGS.
§ 2. Subdivision 3 of section 280-a of the public health law, as
amended by chapter 128 of the laws of 2022, is amended to read as
follows:
3. Prescriptions. (A) A pharmacy benefit manager may not substitute or
cause the substituting of one prescription drug for another in dispens-
ing a prescription, or alter or cause the altering of the terms of a
prescription, except with the approval of the prescriber or as explicit-
ly required or permitted by law, including regulations of the department
of financial services or the department of health. The superintendent
and commissioner, in coordination with each other, are authorized to
promulgate regulations to determine when substitution of prescription
drugs may be required or permitted.
(B) TO THE EXTENT PERMITTED UNDER FEDERAL LAW, A PHARMACY BENEFIT
MANAGER SHALL PAY AN IN-NETWORK PHARMACY AT MINIMUM AT THE NATIONAL
AVERAGE DRUG ACQUISITION COST (NADAC) RATE OR AT THE PHARMACY ACQUISI-
TION COST RATE IF GREATER OR THERE IS NOT A NADAC RATE, PLUS A PROFES-
SIONAL DISPENSING FEE THAT IS AT MINIMUM THE PROFESSIONAL DISPENSING
FEE PAID UNDER THE STATE MEDICAL ASSISTANCE PROGRAM. FOR BRAND NAME
MEDICATIONS AND BIOLOGIC PRODUCTS THAT REQUIRE SPECIAL PACKAGING, SHIP-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD15487-03-4
S. 9570 2
PING OR OTHER COSTS TO BE INCURRED BY THE PHARMACY FOR THE DISPENSING
PROCESS THAT IS GREATER THAN THE PROFESSIONAL DISPENSING FEE PAID BY THE
STATE MEDICAL ASSISTANCE PROGRAM, IN-NETWORK PHARMACIES SHALL BE PAID A
PROFESSIONAL DISPENSING FEE FOR THESE COSTS TO ENSURE AN IN-NETWORK
PHARMACY IS NOT PAID LESS THAN ITS COST TO ACQUIRE AND DISPENSE MEDICA-
TIONS.
§ 3. The opening paragraph of subdivision 4 of section 280-a of the
public health law, as added by chapter 828 of the laws of 2021, is
amended to read as follows:
A pharmacy benefit manager shall, with respect to contracts between a
pharmacy benefit manager and a pharmacy or, alternatively, a pharmacy
benefit manager and a pharmacy's contracting agent, such as a pharmacy
services administrative organization, include a reasonable process to
appeal, investigate and resolve disputes regarding multi-source generic,
BRAND NAME AND BIOLOGIC PRODUCT drug pricing. The appeals process shall
include the following provisions:
§ 4. This act shall take effect immediately.