Assembly Bill (A5882) provides a minimum reimbursement level that pharmacy benefit managers (PBMs) are required to pay participating pharmacies in state-regulated commercial insurance plans. In the final days of the legislative session, we need your help to secure the support needed for this critical legislation to be approved by the New York Assembly.
Although New York State has been a leader in enacting reforms around PBM licensure requirements, state oversight via a new PBM Bureau at the Department of Financial Services, and recent Market Conduct regulations, it has not yet addressed the inadequate payments that PBMs provide to pharmacies, which are often below their costs to procure and dispense prescription drugs for New Yorkers.
This legislation builds on the work of the State Medicaid program which now reimburses pharmacies using a cost-based methodology both for medication costs and pharmacy costs to dispense drugs to patients. Federally, the Centers for Medicare and Medicaid Services’ national acquisition cost survey for covered outpatient drugs is utilized to develop the National Average Drug Acquisition Cost (NADAC) benchmark. The survey collects data from retail community pharmacies on pharmacy ingredient or drug costs in Medicaid. Some states, like New York, reimburse at the NADAC benchmark in their Medicaid programs. Locally, a state and regional cost of dispensing survey has identified costs for New York State. Since 2023, these surveys led State Medicaid to pay pharmacies at NADAC plus the identified dispense fee of $10.18 for covered outpatient drug reimbursement.
This important legislation would require -- at a minimum -- PBMs pay pharmacies at NADAC plus the dispensing fee rate for state-regulated insurance plans. It would also create a process for pharmacies dispensing higher cost medications which may require special handling, increased delivery costs and other special services which increase pharmacy costs to ensure they receive an adequate dispensing fee to cover their costs in these instances.
Join this NACDS RxIMPACT effort to bring fairness and transparency to this process to ensure that pharmacies are able to continue to meet the needs of their communities and stop PBMs practices of paying below-cost reimbursement rates. Help NACDS RxIMPACT build support for this legislation in the New York Assembly! Please type in your contact information, click send message, and the system will generate a letter to your legislator.
Our profession, our industry, and our patients are depending on you. If you have any questions about this communication, please contact Heidi Ecker, Vice President of Government, Political, and Digital Communications via email at Hecker@NACDS.org.