New York 2025-2026 Regular Session

New York Assembly Bill A05882

Introduced
2/24/25  
Refer
2/24/25  

Caption

Requires a pharmacy benefit manager to pay a participating pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under the state medical assistance program.

Impact

If enacted, this bill would substantially impact the financial interactions between pharmacies and PBMs, establishing minimum payment standards that could enhance pharmacies' financial stability. The stipulation that pharmacies cannot be compensated below their acquisition costs is crucial in preventing underpayment practices, potentially leading to improved access to medications for patients as pharmacies may be more inclined to ensure adequate stock if they are assured fair profits on prescription drugs. Additionally, the bill encompasses provisions for the regulation of the pharmacy benefit process and appeals regarding drug pricing disputes.

Summary

Bill A05882 aims to amend certain provisions of the public health law and the insurance law concerning the payments that pharmacy benefit managers (PBMs) must make to participating pharmacies. The bill primarily focuses on ensuring that PBMs pay pharmacies no less than the national average drug acquisition cost (NADAC) rate or the pharmacy acquisition cost rate, plus a professional dispensing fee that reflects the minimum professional dispensing fee under the state medical assistance program. This framework is designed to improve reimbursement practices for pharmacies and ensure fair compensation for dispensing medications.

Contention

Among the notable points of discussion and potential contention surrounding A05882 are concerns related to the regulatory burdens it may impose on PBMs. Proponents of the bill argue that it will promote transparency and equitable payment structures within the pharmaceutical supply chain. However, critics may contend that these regulations could result in increased operational costs for PBMs, which could inadvertently lead to higher drug prices for consumers. The balance between ensuring fair pharmacy reimbursement and maintaining manageable costs for PBMs and consequently for consumers remains a critical aspect of the debate surrounding this legislation.

Companion Bills

NY S05939

Same As Requires a pharmacy benefit manager to pay a participating pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under the state medical assistance program.

Previously Filed As

NY S05939

Requires a pharmacy benefit manager to pay a participating pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under the state medical assistance program.

NY H5254

Requires pharmacy benefit managers to reimburse pharmacist no less than national drug acquisition costs plus fee.

NY S0222

Requires pharmacy benefit managers to reimburse pharmacist no less than national drug acquisition costs plus fee.

NY A08956

Permits the compounding, dispensing and sale of veterinary-specific pharmaceuticals to veterinarians by pharmacists.

NY SB1236

Relating to the relationship between pharmacists or pharmacies and health benefit plan issuers or pharmacy benefit managers.

NY HB1470

Medical Assistance Programs - Drug Dispensing - Cost-of-Dispensing Survey and Fee-for-Service Professional Dispensing Fee

NY HB3317

Relating to the relationship between pharmacists or pharmacies and health benefit plan issuers or pharmacy benefit managers.

NY S06323

Requires the amount paid to a pharmacy for certain high cost drugs be no more than 2.5% of the total cost of such drug plus any dispensing fees.

NY LB138

Change provisions relating to pharmacy dispensing fees under the Medical Assistance Act

NY SB247

Prohibiting network exclusion for pharmacies that refuse to dispense a prescription of the PBM reimbursement that is below the pharmacy's acquisition cost.

Similar Bills

KS HB2551

Enacting the Kansas pharmacy services administrative organization act.

AR SB593

To Amend The Arkansas Pharmacy Benefits Manager Licensure Act; And To Create The Pharmacy Services Administrative Organization Act.

MS HB558

Pharmacy services; prohibit insurers and PBMs from requiring persons to obtain exclusively through pharmacies that they own.

MS HB1125

Pharmacy services; prohibit insurers and PBMs from requiring persons to obtain exclusively through pharmacies that they own.

NJ S2345

"Patient and Provider Protection Act."

AR SB475

To Establish The Pharmacy Services Administrative Organization Act; And To Regulate Pharmacy Services Administrative Organizations.

AZ HB2429

Pharmacy benefits; pharmacy management networks

AZ HB2813

Pharmacy benefits; workers' compensation