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State introduces groundbreaking regs for pharmacy benefit managers

  • / Updated:
  • Staff Report 

New York’s Superintendent of Financial Services, Adrienne A. Harris, unveiled a proposed set of regulations targeting Pharmacy Benefit Managers (PBMs) operating within the state.

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These regulations, once enacted, would be the nation’s most rigorous, aiming to shield consumers and small-scale pharmacies from unfair practices. The new rules primarily focus on preventing manipulative contract clauses that escalate drug prices for consumers and burden local pharmacies. They also implement network adequacy standards to guarantee consumers’ easy access to reasonably priced medications in their vicinity.

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Prior to finalizing these regulations, the state’s Pharmacy Benefits Bureau actively gathered feedback on the influence of PBMs in New York, including collecting information on reporting prerequisites, pharmacy credentialing, and pricing structures. The newly proposed regulations encompass a broad range of protective measures. These measures encompass the prohibition of misleading marketing practices, ensuring patients can access in-network pharmacies conveniently, and forbidding PBMs from favoring their affiliated pharmacies. Moreover, any merger or acquisition activity involving a state-licensed PBM would require the Department’s green light. Following today’s announcement, there is a 60-day comment period for the public and stakeholders to provide feedback on these proposed regulations. Further details can be found on the DFS website, and the public can report any PBM misconduct or concerns about prescription drug prices directly to the department.