Loading chat...
NY S05939
Bill
Status
6/13/2025
Primary Sponsor
James Skoufis
Click for details
AI Summary
-
Requires pharmacy benefit managers (PBMs) to pay participating pharmacies at minimum the national average drug acquisition cost (NADAC) rate, or the pharmacy's actual acquisition cost if no NADAC rate exists, plus a professional dispensing fee matching at least the state Medicaid program rate
-
Mandates additional dispensing fees for medications requiring special handling, unique distribution, in-depth patient teaching, coordination of care, or special monitoring to ensure pharmacies are not paid below their actual costs
-
Establishes an appeals process for pharmacies to dispute pricing on multi-source generic drugs, brand name drugs, biologic products, and drugs produced through genetic technology or biopharmaceutical processes
-
Exempts collectively bargained health plans, trust funds established under the Labor Management Relations Act, and multi-employer plans from these requirements
-
Takes effect January 1, 2026, applying to all insurance policies and contracts issued, renewed, modified, altered, or amended on or after that date
Legislative Description
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.
Last Action
AMENDED ON THIRD READING 5939C
3/11/2026