SB 665-FN introduces significant amendments to the regulations governing pharmacy benefits managers (PBMs) and their interactions with health carriers. The bill requires a written agreement between PBMs and health carriers that outlines the PBM's duties and fiduciary responsibilities. It increases the maximum administrative fine for violations from $2,500 to $10,000 per violation, with each day of non-compliance treated as a separate violation. Additionally, pharmacies are mandated to inform consumers of their right to request the lowest available price for prescription drugs, and health carriers or PBMs are prohibited from penalizing consumers for using specific pharmacy providers. The bill also enhances reporting requirements, necessitating semi-annual financial reports from PBMs to the commissioner, while ensuring that the acts of a PBM are considered the acts of the health carrier they represent.

Further amendments include the requirement for contracts between health carriers and pharmacies to detail drug reimbursement calculations and establish a structured process for appealing pricing disputes. The notice period for formulary deletions is extended from 45 to 60 days, and health carriers must notify providers of retroactive claims denials 15 days in advance. The bill also introduces new definitions for PBMs and spread pricing, while maintaining consumer protections by ensuring transparency in drug pricing. Set to take effect on January 1, 2027, the bill is expected to have an indeterminable impact on state revenue and expenditures, particularly regarding health insurance premiums and the insurance premium tax, as changes in PBM practices may lead to fluctuations in these areas.

Statutes affected:
Introduced: 318:5-a
As Amended by the Senate: 402-N:1, 402-N:2, 420-J:8, 420-J:7-b, 420-J:8-b, 415-A:7