NY A06352

Requires health insurers offering coverage under Articles 32 and 43 to use pass-through pricing models for pharmacy benefit manager contracts, limiting payments to actual ingredient costs, dispensing fees, and a capped administrative fee.

Mandates pharmacy benefit managers disclose all income sources to insurers and the Department of Insurance, including rebates, discounts, inflationary payments, clawbacks, and fees, with all such amounts passed through to reduce costs.

Prohibits spread pricing arrangements where pharmacy benefit managers charge amounts exceeding what they pay pharmacies plus administrative fees; any excess must be remitted to health plans quarterly.

Requires pharmacy benefit managers to identify all ingredient costs and dispensing fees paid to pharmacies and make administrative fee payment models available for departmental review and approval.

Subjects any premium changes resulting from these contracts to Department of Insurance approval; takes effect immediately upon enactment.