On November 20, the State Department of Financial Services made final PBM market conduct regulations. The regulations will become effective on November 27, 2024. The market conduct regulations require the following:
- Allow Home Delivery. 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;
- List Pharmacy Directories. 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;
- Address Consumer Inquiries. 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 Steering. Prohibit anti-competitive practices that steer consumers away from their community pharmacy to larger pharmacies affiliated with the PBM;
- Treat Pharmacies Fairly. Prohibit PBMs from unfairly passing losses onto pharmacies when the PBM mistakenly approved dispensing a drug and then seeks to retroactively deny reimbursement to the pharmacy;
- Allow Electronic Submissions. Reduce administrative burdens and costs on small pharmacies by allowing them to submit information to and receive information from PBMs electronically; and
- Apply Same Standards. 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.
Also in New York, on November 20, NYRx, the Medicaid Pharmacy Benefit Program, held its monthly pharmacy industry call. Two items on the agenda were (1) Non-Individual Specific Prescription for Self-Administered Hormonal Contraceptives with Pharmacy Dispensing Protocol
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
