During the 2021 legislative session, the New York State Legislature passed three bills called the Pharmacy Rescue Package (A1396/S3762, A5457/S3566, and A7598/S6603) to regulate Pharmacy Benefit Managers (PBMs). All three bills have overwhelming support from state legislators, with A1396/S3762 passing the Assembly unanimously and A7598/S6603 passing both houses unanimously.

For decades, PBMs have been the invisible hand behind prescription drug prices and programs, deciding how much to bill the health insurance companies per prescription and how much they will reimburse the pharmacy for dispensing the medications. Since PBMs are not regulated, this has caused PBMs to pocket the difference in what the health insurance companies pay and how much PBMs pay pharmacists - called spread pricing. This often causes pharmacists to dispense these medications at a loss and is negatively impacting small independent pharmacists who face closure because they cannot afford these low costs.

Additionally, PBMs are costing the state millions of dollars every year due to Medicaid coverage. Currently, Medicaid prescriptions are either covered through a Fee-For-Service program or managed care organizations. Managed care organizations work directly with PBMs and has cost the state $605 million from 2016-2019 according to a 2020 report from the Office of the New York State Comptroller because PBMs do not consider federal rebate programs when recommending prescription drugs. A7598/S6603 would require PBMs to follow the same rules as Fee-For-Service so that PBMs must consider federal rebate programs in their recommendations as well.

“Like many small rural communities, the North Country depends on small independent pharmacists because of the level of trust they are able to build with their local neighborhood pharmacists. PBMs not only jeopardize this relationship by dictating which prescriptions health insurance companies will cover, but also threaten the very existence of these small independent pharmacies because they cannot afford the reimbursement prices set by PBMs. It is unacceptable that the state continues to lose millions of dollars every year due to these practices and I am proud to co-sponsor A7598 and A1396 that will finally regulate PBMs because these bills will preserve patient choice, save the taxpayers money, and help small independent pharmacies continue their important work in our communities. It’s time that the Governor signs these bills and provide this important lifeline to our local pharmacists.”

“Prescription drug middlemen known as pharmacy benefit managers have raked in billions of dollars in record profits off this pandemic by doing what they always do: keeping drug prices high, reducing patient choice, ripping off taxpayers and putting neighborhood pharmacies out of business,” said Steve Moore, past president of the Pharmacists Society of the State of New York (PSSNY) and owner of Condo Pharmacy in Plattsburgh. “At a time when few agree on much, the Majority, Minority, healthcare providers, patients, taxpayers and lawmakers all are urging Governor Hochul protect New Yorkers by signing the Pharmacy Rescue Package.”

“The pandemic has underscored how critical independent pharmacies are to keeping our communities in Clinton County and across the state healthy, and pharmacy benefit managers are putting the lives of our patients in danger every day they remain unregulated” said Dan Bosley, pharmacist and owner of Keeseville Pharmacy in Keeseville and Cornerstone Drug & Gift in Rouses Point. “We are pleading with Governor Hochul to put the health of our fellow New Yorkers over the profits of Fortune 15 corporations and sign the full Pharmacy Rescue Package.”

All three bills have been delivered to the Governor and she has until the end of the year to sign them. Otherwise, the bills return to the State Legislature where they must be voted on again.