Prohibits pharmacy benefit managers from penalizing pharmacies for providing customers certain information relating to the costs of prescription medications and services.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A9764
SPONSOR: Rosenthal L TITLE OF BILL:
An act to amend the public health law, in relation to prohibiting phar-
macy benefit managers from penalizing pharmacies for providing customers
certain information relating to the costs of prescription medications
PURPOSE:
To allow pharmacies to disclose prescription drug costs and reimburse-
ment rates.
SUMMARY OF SPECIFIC PROVISIONS:
Section one amends subdivision five of section 280-a of the public
health law.
Section two establishes the effective date.
JUSTIFICATION:
In 2018, New York State enacted a law to prevent pharmacy benefit manag-
ers (PBMs) from penalizing pharmacies that inform customers when a
prescription will be cheaper out-of-pocket instead of being run through
their insurance. This change helped ensure greater transparency while
also allowing patients to receive the lowest cost for their medication.
A 2024 report by the Community Oncology Alliance found that PBMs
routinely reimburse pharmacies below the cost of doing business, endan-
gering their ability to provide proper care and lifesaving medications
to the communities they serve. To ensure pharmacies, particularly small
and independent pharmacies, can continue to operate, it is imperative
that greater transparency measures are in place. This legislation would
further protect pharmacies from penalties imposed by PBMs for discussing
prescription drug costs to the pharmacy and their reimbursement rates.
LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATIONS:
None to the State.
EFFECTIVE DATE:
This act shall take effect immediately.
STATE OF NEW YORK
________________________________________________________________________
9764
IN ASSEMBLY
April 4, 2024
___________
Introduced by M. of A. L. ROSENTHAL -- read once and referred to the
Committee on Health
AN ACT to amend the public health law, in relation to prohibiting phar-
macy benefit managers from penalizing pharmacies for providing custom-
ers certain information relating to the costs of prescription medica-
tions
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 5 of section 280-a of the public health law,
2 as amended by chapter 128 of the laws of 2022, is amended to read as
3 follows:
4 5. Contract provisions. No pharmacy benefit manager shall, with
5 respect to contracts between such pharmacy benefit manager and a pharma-
6 cy or, alternatively, such pharmacy benefit manager and a pharmacy's
7 contracting agent, such as a pharmacy services administrative organiza-
8 tion:
9 (a) prohibit or penalize a pharmacist or pharmacy from disclosing to
10 an individual purchasing a prescription medication or service informa-
11 tion regarding:
12 (i) the cost of the prescription medication or service to the individ-
13 ual, or the cost of the prescription medication or service to the phar-
14 macy and the pharmacy's reimbursement for that prescription medication
15 or service; or
16 (ii) the availability of any therapeutically equivalent alternative
17 medications or alternative methods of purchasing the prescription medi-
18 cation, including but not limited to, paying a cash price; or
19 (b) charge or collect from an individual a copayment that exceeds the
20 total submitted charges by the pharmacy for which the pharmacy is paid.
21 If an individual pays a copayment, the pharmacy shall retain the adjudi-
22 cated costs and the pharmacy benefit manager shall not redact or recoup
23 the adjudicated cost.
24 § 2. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD14486-03-4
