New York 2025-2026 Regular Session

New York Senate Bill S05939

Introduced
3/4/25  
Refer
3/4/25  
Engrossed
6/13/25  
Refer
6/13/25  
Refer
1/7/26  
Engrossed
2/24/26  

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, S05939 would significantly alter the landscape of pharmacy reimbursements by changing state law concerning the pricing strategies employed by PBMs. By enforcing these minimum payment standards, the bill intends to alleviate the financial strain on pharmacies, thereby promoting their viability and sustainability. This is particularly crucial for independent pharmacies that may struggle under the current variable pricing structures imposed by PBMs. The new reimbursement requirements are expected to positively impact pharmacy operations and patient access to medications.

Summary

Bill S05939 aims to regulate the payment practices of pharmacy benefit managers (PBMs) towards participating pharmacies. The bill mandates that PBMs must pay these pharmacies at least the national average drug acquisition cost (NADAC) or the pharmacy acquisition cost rate if NADAC is unavailable. Additionally, it incorporates a professional dispensing fee that meets or exceeds the one established under the state medical assistance program. This legislation focuses on enhancing financial transparency and ensuring pharmacies are compensated fairly for the medications they dispense.

Contention

Notable points of contention around S05939 revolve around the potential impacts on PBMs and the broader healthcare market. Supporters argue that the bill will protect pharmacies from unjustly low reimbursements and ensure patients continue to have access to affordable medications. However, critics raise concerns that such regulations could lead to increased costs for health plans, potentially resulting in higher premiums for consumers. Moreover, there are apprehensions that PBMs might respond by increasing their administrative fees, which could counteract the intended benefits of the legislation.

Companion Bills

NY A05882

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 A05882

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 SB247

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

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.

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.

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