What's happening
Writing a plain-English summary… Track this bill to get it by email.
Why it matters
Albany, before your first meeting.
Every bill that moved yesterday, summarized in a sentence and ranked by impact. The Albany Scorecard follows on Sundays.
Free. Unsubscribe in one click. Want alerts on specific bills? Create an account.
Who cares
Headline styles
Sponsors
History
- Signed chap.540
- Delivered to governor
- Returned to senate
- Passed assembly
- Ordered to third reading rules cal.50
- Substituted for A676C
- Referred to ways and means
- Delivered to assembly
- Passed senateVote 59–2
- Advanced to third reading
- 2nd report cal.
- 1st report cal.1273
Show 6 earlier actions
- Print number 3346b
- Amend and recommit to finance
- Reported and committed to finance
- Print number 3346a
- Amend and recommit to health
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Relates to establishing a pharmacy benefit manager contract appeals process
Assembly Floor Calendar · Sponsor Linda Rosenthal
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
BILL NUMBER:S3346B
Title of bill
An act to amend the public health law, in relation to pharmacy benefit managers
Purpose
To requires contracts between pharmacy benefit managers and pharmacies to include a reasonable appeals process.
Summary of provisions
Section one adds a new § 280-a to the Public Health Law to require contracts between a pharmacy benefit manager (PBM) and a pharmacy, or a pharmacy's contract agent, to include a reasonable appeals process. Under the process, the right to appeal is limited to 30 days following the initial claim submission. The PBM must provide a phone number and email for processing the appeal, and must respond to an appeal within 7 business days. If the appeal is deemed valid, the price is adjusted for the appealing pharmacy effective the date of the original claim and, if warranted, the PBM shall update the maximum allowable cost for all similarly situated pharmacies. If the appeal is denied, the PBM shall identify a therapeutically equivalent drug that is available for purchase at an equal price.
Section two provides that this act shall take effect 90 days after enactment.
Justification
Pharmacy benefit managers (PBMs) are business entities that manage the pharmacy benefit for health plans, employers and other payers. Services include managing pharmacy networks by contracting with pharmacy providers, establishing reimbursement rates for brands and generics, paying pharmacies for submitted claims, managing formularies, establishing co-payment amounts and other services.
Contracts between PBMs and pharmacies include reimbursement policies. For brand drugs, contracts between pharmacies and PBMs refer to published pricing benchmarks such as Wholesaler Acquisition Cost and Average Wholesale Price. On the other hand, for generics PBM contracts refer to Maximum Allowable Cost (MAC). MAC price lists for generics are developed and managed by individual PBMs and are not included in with the contracts that are presented to pharmacies or their contracting agents. Since each patient's policy may be governed by a different MAC list that the pharmacist does not have access to, a pharmacy typically will not know the reimbursed amount of the drug prior to filling a prescription.
The recent unprecedented fluctuation in generic drug prices has generated significant attention and highlighted the need for this legislation. Under this legislation, contracts would be required to include a process by which a pharmacy can appeal a MAC price that is below its cost, with a reasonable timeline for both the pharmacy to appeal and for the PBM to respond. Similar legislation has been
enacted in 16 other states as well as the Medicare Part D policy scheduled to take effect in January, 2016.
Legislative history
Similar to S.7025-A of 2014
Fiscal implications
None.
Effective date
90 days after enactment
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.