New York A 9045: Relates to reimbursements practices of pharmacy benefit managers

Bill Text

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A09045 Summary:

BILL NOA09045 

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SAME ASSAME AS S05719

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SPONSORKelles

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COSPNSR

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MLTSPNSR

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Amd §280-a, Pub Health L

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Ensures reimbursement practices of pharmacy benefit managers do not allow for reimbursement of an amount less than the cost of procuring the drugs.

Go to top A09045 Actions:

BILL NOA09045 

&nbsp

09/05/2025referred to health

01/07/2026referred to health

Go to topA09045 Committee&nbspVotes:

Go to topA09045 Floor&nbspVotes:

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

Go to topA09045 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 9045

 2025-2026 Regular Sessions

 IN ASSEMBLY

 September 5, 2025
 ___________

 Introduced by M. of A. KELLES -- read once and referred to the Committee
 on Health

 AN ACT to amend the public health law, in relation to reimbursement
 rates of pharmacy benefit managers

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

 1 Section 1. Paragraph (e) of subdivision 4 of section 280-a of the
 2 public health law, as added by chapter 828 of the laws of 2021, is
 3 amended and a new subdivision 4-a is added to read as follows:
 4 (e) (i) if an appeal is denied, the pharmacy benefit manager shall
 5 identify the national drug code of a therapeutically equivalent drug, as
 6 determined by the federal Food and Drug Administration, that is avail-
 7 able for purchase by pharmacies in this state from wholesalers regis-
 8 tered pursuant to subdivision four of section sixty-eight hundred eight
 9 of the education law that the pharmacist or pharmacy purchases the
 10 majority of prescription drugs for resale from at a price which is equal
 11 to or less than the maximum allowable cost or other reimbursement pric-
 12 ing methodology used by the pharmacy benefits manager to determine cost
 13 for that drug as determined by the pharmacy benefit manager.
 14 (ii) if the national drug code number provided by the pharmacy bene-
 15 fit manager is not available below the pharmacy acquisition cost from
 16 the pharmaceutical wholesaler from whom the pharmacy or pharmacist
 17 purchases the majority of prescription drugs for resale, then the phar-
 18 macy benefit manager shall adjust the maximum allowable cost or other
 19 pricing methodology used by the pharmacy benefits manager to determine
 20 cost above the challenging pharmacy's pharmacy acquisition cost and
 21 permit the pharmacy to reverse and rebill each claim affected by the
 22 inability to procure the drug at a cost that is equal to or less than
 23 the previously challenged maximum allowable cost.
 24 4-a. Reimbursement. (a) A pharmacy benefit manager shall not reimburse
 25 a pharmacy or pharmacist in this state an amount less than the amount

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD00145-01-5

 A. 9045 2

 1 that the pharmacy benefit manager reimburses a pharmacy benefit manager
 2 affiliate for providing the same pharmacist services.
 3 (b) The amount shall be calculated on a per unit basis based on the
 4 same generic product identified or generic code number.
 5 § 2. This act shall take effect on the ninetieth day after it shall
 6 have become a law.

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