The bill amends the Pharmacy Benefits Manager Regulation Act to introduce new definitions and prohibitions regarding the practices of pharmacy benefits managers (PBMs) in New Mexico. Notably, it defines "patient steering" as practices that direct patients to preferred pharmacies through mandatory mail orders, restricted pharmacy networks, or copay differentials. Additionally, it introduces "spread pricing," which refers to the practice of PBMs reimbursing pharmacies at a lower rate than what they charge insurers or employers. The bill also clarifies the roles and definitions of pharmacists, pharmacies, and pharmacy benefits managers, ensuring that the language reflects current practices and standards.

Furthermore, the bill prohibits PBMs from engaging in certain practices, such as conducting patient steering and spread pricing, and mandates transparency in their contracts with pharmacies. PBMs are required to provide contracts in plain English and cannot impose fees based on performance metrics. The legislation also protects pharmacies from being penalized for clerical errors during audits unless those errors result in actual overpayments or dispensing the wrong medication. Overall, the bill aims to enhance transparency and fairness in the pharmacy benefits management process, ultimately benefiting both pharmacies and patients.

Statutes affected:
introduced version: 59A-61-2, 59A-61-5