Relates to payments by a pharmacy benefit manager to participating pharmacies

Summary

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.

Summary from NY Open Legislation. How we handle summaries

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Purpose, from the sponsor's memo

Section 1: Amends subdivision 1 of section 280-a of the public health law by adding paragraphs (j) and (k). To define the Pharmacy Acquisition Cost Rate as the cost a participating pharmacy pays to acquire drugs, including generic, brand-name, biologics, and those produced through genetic or biopharmaceutical processes, based on pharmacy cost invoices. It also defines the National Average Drug Acquisition Cost as the month- ly survey conducted by the Centers for Medicare and Medicaid Services (CMS) to determine the average acquisition cost of Medicaid-covered outpatient drugs. Section 2: Amends subdivision 3 of section 280-a of the public health law to add a paragraph (b). To prohibit pharmacy benefit managers from substituting or altering prescription drugs without prescriber approval or legal authorization. The superintendent and commissioner may issue regulations on when substitutions are permitted. Additionally, pharmacy benefit managers must reimburse participating pharmacies at least the National Average Drug Acquisition Cost (NADAC) rate or the Pharmacy Acquisition Cost Rate, whichever is higher, plus a professional dispens- ing fee equal to that paid under the state medical assistance program. For medications requiring specialized handling, distribution, adminis- tration, patient education, care coordination, monitoring, special pack- aging, or shipping, pharmacies must receive an additional dispensing fee to ensure they are not reimbursed below their acquisition and dispensing costs. Section 3: Amends the opening paragraph of subdivision 4 of section 280-a of the public health law. To require pharmacy benefit managers to establish a. reasonable process for pharmacies or their contracting agents to appeal, investigate, and resolve disputes over drug pricing for multi-source generics, brand-name drugs, biologics, and drugs produced through genetic or biopharmaceutical processes. Section 4: Amends section 2911 of the insurance law to add a new subsection (d) to ensure that pharmacy benefit managers reimburse phar- macies fairly by covering the actual cost of acquiring and dispensing medications. It mandates payment at either the National Average Drug Acquisition Cost (NADAC) rate or the Pharmacy Acquisition Cost Rate, if there is not a NADAC rate, along with a professional dispensing fee. Additional compensation is required for drugs needing special handling, administration, or monitoring. The amendment also establishes a stand- ardized appeals process for pharmacies to dispute pricing issues. This paragraph does not apply to prescriptions or prescription drugs that are distributed or paid for by a trust fund established under the Labor Management Relations Act, or provided through a health, welfare, or pharmaceutical plan that has been created, adopted, or funded as part of a collective bargaining agreement between an employer and a labor organ- ization or certified employee organization. Section 5: Sets Effective Date.

Filed with the bill. Read it on nysenate.gov (opens in a new tab)

Where it stands

Passed the legislature and is awaiting a signature.

Health · New York State Assembly

Also referred to Health · New York State Senate, Insurance · New York State Assembly, Insurance · New York State Senate, Ways and Means · New York State Assembly.

Recorded votes

• Vote: Floor vote

  NY SenateMay 28, 2026Result: passed

  Voted yes (58)Voted no (2)Voted present (0)Absent (3)

  See member positions for the vote on May 28, 2026 (Floor vote)

• Vote: Floor vote

  NY SenateFeb 24, 2026Result: passed

  Voted yes (55)Voted no (1)Voted present (0)Absent (7)

  See member positions for the vote on Feb 24, 2026 (Floor vote)

• Vote: Committee vote · Health

  Senate HealthFeb 9, 2026Result: passed

  Voted yes (14)Voted no (0)Voted present (0)Absent (1)

  See member positions for the vote on Feb 9, 2026 (Committee vote · Health)

• Vote: Floor vote

  NY SenateJun 13, 2025Result: passed

  Voted yes (57)Voted no (2)Voted present (0)Absent (4)

  See member positions for the vote on Jun 13, 2025 (Floor vote)

• Vote: Committee vote · Rules

  Senate RulesJun 12, 2025Result: passed

  Voted yes (20)Voted no (0)Voted present (0)Absent (1)

  See member positions for the vote on Jun 12, 2025 (Committee vote · Rules)

Full history

1. Jun 5, 2026

   Passed a chamber

   PASSED ASSEMBLY

   NY Assembly

2. Jun 5, 2026

   Returned to Senate

   RETURNED TO SENATE

   NY Assembly

3. Jun 4, 2026

   Reported out of committee

   REPORTED REFERRED TO RULES

   NY Assembly

4. Jun 4, 2026

   Rules Report CAL.483

   RULES REPORT CAL.483

   NY Assembly

5. Jun 4, 2026

   Substituted

   SUBSTITUTED BY S5939C

   NY Assembly