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AMAC Action Submits Comments on PBM Reform to NY State

Posted on Friday, February 16, 2024
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by AMAC Action
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AMAC Action submitted comments to New York state’s Department of Financial Services this week in response to its request to hear from stakeholders regarding new rules for pharmacy benefit managers (PBM). According to an article posted by The Well News, the “market conduct” regulations seek “to put an end to unfair practices by the PBM industry, making prescription drugs more affordable and accessible for New Yorkers”.

The Well News reported the proposed regulations would:

  • Prohibit PBMs from barring any in-network pharmacies from providing mail order or delivery services, which will increase patients’ access to home delivery from their community pharmacy.
  • Increase transparency to consumers and employers by requiring PBMs to list formularies and pharmacy directories online, and prohibiting PBMs from punishing a consumer who relies on said information.
  • Require PBMs to post a telephone number and email address for consumers to direct their questions to, and PBMs must respond in a reasonable amount of time.
  • Prohibit anti-competitive practices that steer consumers away from their community pharmacy to larger pharmacies affiliated with the PBM.
  • Prohibit PBMs from unfairly passing losses onto pharmacies when the PBM mistakenly approves dispensing a drug and then seeks to retroactively deny reimbursement to the pharmacy.
  • Reduce administrative burdens and costs on small pharmacies by allowing them to submit information to and receive information from PBMs electronically.
  • Prevent the abuse of audits against small pharmacies who are not affiliated with a PBM by requiring PBMs to apply the same audit standards across all in-network pharmacies.

AMAC Action recognizes that while these regulations are certainly welcome reforms, much more work needs to be done to address the anti-competitive business practices that are pervasive within the outpatient prescription supply chain and increase costs for patients. As part of our response, AMAC Action included our PBM white paper that, among others, details the issues with rapid vertical integration among PBMs and payers, pharmacy gag orders, administrative fees, and spread pricing.

AMAC Action has been engaged in the mission to reform pharmacy benefit manger business practices for several years and continues our advocacy for transparency and market reforms to lower drug costs for AMAC members and all Americans.

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