NY A07357

Expands the definition of "pharmacy benefit management services" to include the management and administration of benefits relating to durable medical equipment (DME), subjecting DME providers to the same regulations as pharmacies under PBM oversight

Defines "durable medical equipment" as devices ordered by practitioners that can withstand repeated use, are primarily for medical purposes, are generally not useful without illness/injury, and includes medical/surgical supplies, orthotic appliances, and orthopedic footwear

Extends existing PBM audit requirements and protections to durable medical equipment providers, including 15-day advance notice for on-site audits, 24-month audit period limits, and 100-prescription audit caps

Prohibits PBMs from penalizing pharmacies or DME providers for disclosing cost information to patients, including reimbursement rates and availability of therapeutically equivalent alternatives

Requires insurers and PBMs to provide cost-sharing information for both prescription drugs and durable medical equipment upon request, using billing codes such as National Drug Codes or Healthcare Common Procedure Coding System codes