New York S 8098: Relates to pharmacy benefit management services and durable medical equipment

Bill Text

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S08098 Summary:

BILL NOS08098 

&nbsp

SAME ASSAME AS A07357

&nbsp

SPONSORBAILEY

&nbsp

COSPNSRFAHY, FERNANDEZ, RYAN C

&nbsp

MLTSPNSR

&nbsp

Amd §§280-a, 280-c & 4408, Pub Health L; amd §§111-a, 2901, 2902, 2905, 2906, 3217-a & 4324, Ins L

&nbsp

Expands pharmacy benefit management services to include the management or administration of benefits relating to durable medical equipment; defines "durable medical equipment"; relates to pharmacy or durable medical equipment provider audits by pharmacy benefit managers.

Go to top S08098 Actions:

BILL NOS08098 

&nbsp

05/15/2025REFERRED TO HEALTH

01/07/2026REFERRED TO HEALTH

Go to topS08098 Committee&nbspVotes:

Go to topS08098 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topS08098 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 8098

 2025-2026 Regular Sessions

 IN SENATE

 May 15, 2025
 ___________

 Introduced by Sen. BAILEY -- read twice and ordered printed, and when
 printed to be committed to the Committee on Health

 AN ACT to amend the public health law and the insurance law, in relation
 to pharmacy benefit management services and durable medical equipment

 The People of the State of New York, represented in Senate and Assem-
 bly, do enact as follows:

 1 Section 1. Subdivisions 1, 3, 4 and 5 of section 280-a of the public
 2 health law, subdivisions 1 and 3 as amended by chapter 128 of the laws
 3 of 2022, subdivision 4 as added by chapter 828 of the laws of 2021, and
 4 subdivision 5 as amended by chapter 396 of the laws of 2024, are amended
 5 to read as follows:
 6 1. Definitions. As used in this section, the following terms shall
 7 have the following meanings:
 8 (a) "Health plan" means an entity for which a pharmacy benefit manager
 9 provides pharmacy benefit management services and that is a health bene-
 10 fit plan or other entity that approves, provides, arranges for, or pays
 11 or reimburses in whole or in part for health care items or services, to
 12 include at least prescription drugs or durable medical equipment, for a
 13 substantial number of beneficiaries who work or reside in this state.
 14 The superintendent shall determine, in [his or her] such superinten-
 15 dent's sole discretion, by regulation how the phrase "a substantial
 16 number of beneficiaries who work or reside in this state" shall be
 17 interpreted.
 18 (b) "Pharmacy benefit management services" means the management or
 19 administration of prescription drug benefits or the management or
 20 administration of benefits relating to durable medical equipment, for a
 21 health plan, directly or through another entity, and regardless of
 22 whether the pharmacy benefit manager and the health plan are related, or
 23 associated by ownership, common ownership, organization or otherwise;
 24 including the procurement of prescription drugs to be dispensed to
 25 patients, [or] the administration or management of prescription drug

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD10971-01-5

 S. 8098 2

 1 benefits, or the administration or management of benefits relating to
 2 durable medical equipment, including but not limited to, any of the
 3 following:
 4 (i) mail service pharmacy;
 5 (ii) claims processing, retail network management, or payment of
 6 claims to pharmacies for dispensing prescription drugs;
 7 (iii) clinical or other formulary or preferred drug list development
 8 or management;
 9 (iv) negotiation or administration of rebates, discounts, payment
 10 differentials, or other incentives, for the inclusion of particular
 11 prescription drugs in a particular category or to promote the purchase
 12 of particular prescription drugs;
 13 (v) patient compliance, therapeutic intervention, or generic substi-
 14 tution programs;
 15 (vi) disease management;
 16 (vii) drug utilization review or prior authorization;
 17 (viii) adjudication of appeals or grievances related to prescription
 18 drug coverage;
 19 (ix) contracting with network pharmacies; [and]
 20 (x) controlling the cost of covered prescription drugs; and
 21 (xi) credentialing, contracting, authorizing, processing payment, or
 22 acting as an intermediary for the mana