Assembly Bill A6764

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6764
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 12, 2025
                                ___________
 
 Introduced by M. of A. WEPRIN -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the insurance law, in relation to reporting requirements
   for pharmacy benefit managers
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Paragraph 1 of subsection (a) of section 2904 of the insur-
 ance law, as amended by chapter 128 of the laws of 2022, is  amended  to
 read as follows:
   (1)  (I)  On or before July first of each year, every pharmacy benefit
 manager shall report to the superintendent, in  a  statement  subscribed
 and  affirmed  as  true  under  penalties  of  perjury,  the information
 requested by the superintendent including, without limitation,
   [(i)] (A) any pricing discounts, rebates  of  any  kind,  inflationary
 payments, credits, clawbacks, fees, grants, chargebacks, reimbursements,
 other   financial  or  other  reimbursements,  incentives,  inducements,
 refunds or other benefits received  by  the  pharmacy  benefit  manager;
 [and]
   [(ii)]  (B)  the  terms and conditions of any contract or arrangement,
 including other financial or other  reimbursements  incentives,  induce-
 ments  or  refunds  between  the  pharmacy benefit manager and any other
 party relating to pharmacy benefit management  services  provided  to  a
 health  plan including but not limited to, dispensing fees paid to phar-
 macies[.];
   (C) THE AGGREGATED DOLLAR AMOUNT OF REBATES,  FEES,  PRICE  PROTECTION
 PAYMENTS  AND  ANY  OTHER PAYMENTS THE PHARMACY BENEFIT MANAGER RECEIVED
 FROM DRUG MANUFACTURERS THROUGH REBATE CONTRACTS;
   (D) THE PORTIONS OF THE AMOUNT IN  CLAUSE  (C)  OF  THIS  SUBPARAGRAPH
 WHICH WERE:
   1. PASSED ON TO HEALTH PLANS; OR
   2. RETAINED BY THE PHARMACY BENEFIT MANAGER; AND
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10316-01-5
              

 A. 6764                             2
 
   (E) FOR EACH REBATE CONTRACT IN EFFECT DURING THE REPORTING PERIOD:
   1. THE NAMES OF THE CONTRACTING PARTIES;
   2.  THE  EXECUTION DATE AND THE TERM OF THE CONTRACT, INCLUDING EXTEN-
 SIONS;
   3. THE NAME OF THE  DRUGS  AND  THE  ASSOCIATED  NATIONAL  DRUG  CODES
 COVERED BY THE REBATE CONTRACT, AND FOR EACH DRUG:
   (I)  A  SUMMARY  OF  THE CONTRACT TERMS REGARDING FORMULARY PLACEMENT,
 FORMULARY EXCLUSION, OR PRIOR AUTHORIZATION REQUIREMENTS OR STEP  EDITS,
 OF ANY DRUGS CONSIDERED TO COMPETE WITH EACH DRUG;
   (II)  A  SUMMARY  OF  ALL  TERMS  REQUIRING OR INCENTIVIZING VOLUME OR
 MARKET SHARE FOR EACH  DRUG,  INCLUDING  BASE  REBATE  AMOUNTS,  BUNDLED
 REBATES  AND  INCREMENTAL  REBATES, STATED SEPARATELY, AND PRICE CONCES-
 SION, STATED SEPARATELY FOR EACH DRUG; AND
   (III) THE TOTAL NUMBER OF PRESCRIPTIONS FILLED AND UNITS DISPENSED FOR
 WHICH A REBATE, DISCOUNT, PRICE CONCESSION OR  OTHER  CONSIDERATION  WAS
 RECEIVED BY THE PHARMACY BENEFIT MANAGER FOR EACH DRUG;
   4.  THE  REBATE  PERCENTAGE AND DOLLAR AMOUNT RETAINED BY THE PHARMACY
 BENEFIT MANAGER FOR EVERY REBATE, DISCOUNT, PRICE  CONCESSION  OR  OTHER
 CONSIDERATION UNDER EACH REBATE CONTRACT; AND
   5. THE DOLLAR AMOUNT OF ANY OTHER COMPENSATION PAID BY A DRUG MANUFAC-
 TURER  TO A PHARMACY BENEFIT MANAGER FOR SERVICES INCLUDING DISTRIBUTION
 MANAGEMENT SERVICES, DATA OR DATA  SERVICES,  MARKETING  OR  PROMOTIONAL
 SERVICES,  RESEARCH  PROGRAMS,  OR  OTHER ANCILLARY SERVICES, UNDER EACH
 REBATE CONTRACT.
   (II) FOR THE PURPOSES OF THIS SUBSECTION, THE TERM  "REBATE  CONTRACT"
 MEANS  ANY AGREEMENT ENTERED INTO BY A PHARMACY BENEFIT MANAGER WITH ANY
 DRUG MANUFACTURER OR AGENT OR AFFILIATE  OF  A  DRUG  MANUFACTURER  THAT
 DETERMINES  ANY  REBATE,  DISCOUNT,  ADMINISTRATIVE  OR OTHER FEE, PRICE
 CONCESSION,  OR  OTHER  CONSIDERATION  RELATED  TO  THE  DISPENSING   OF
 PRESCRIPTION DRUGS FOR A HEALTH PLAN.
   § 2. Severability. If any provision of this act, or any application of
 any  provision of this act, is held to be invalid, that shall not affect
 the validity or effectiveness of any other provision of this act, or  of
 any other application of any provision of this act.
   § 3. This act shall take effect on the one hundred eightieth day after
 it shall have become a law.