New York state is introducing updated regulations targeting pharmacy benefit managers (PBMs), the intermediaries responsible for negotiating prescription drug prices between wholesalers and pharmacies.

Governor Kathy Hochul’s office stated that the new measures aim to safeguard access to prescription drugs, curb practices that inflate costs, and enable independent pharmacies to compete more effectively with larger counterparts, some of which own their own PBMs.

The regulations also focus on improving transparency and simplifying access to prescription medications.

“New Yorkers deserve access to affordable and fair-priced prescription drugs, and these regulations ensure that consumers and small pharmacies are shielded from unfair business practices,” Hochul announced. “We are creating a level playing field for independent pharmacies while promoting competition and empowering consumers. These changes will enhance access to essential medications, eliminate anti-competitive practices, and ensure the health care system works for everyone—not just major players.”

The Department of Financial Services has been tasked with overseeing the implementation of these regulations and addressing any issues related to PBMs.

The market conduct regulations require the following:

  • Allow Home Delivery: PBMs must allow all in-network pharmacies to offer mail-order or delivery services, enhancing patient access to home delivery options from local pharmacies.
  • List Pharmacy Directories: PBMs are required to make formularies and pharmacy directories accessible online, increasing transparency for consumers and employers. Additionally, PBMs cannot penalize consumers for relying on this information.
  • Address Consumer Inquiries: PBMs must provide a phone number and email for consumer inquiries and respond within a reasonable timeframe.
  • Prohibit Steering: PBMs are prohibited from engaging in practices that redirect consumers away from community pharmacies toward larger, PBM-affiliated pharmacies.
  • Treat Pharmacies Fairly: PBMs are barred from unfairly imposing financial losses on pharmacies due to retroactive reimbursement denials following PBM errors.
  • Allow Electronic Submissions: Small pharmacies will benefit from reduced administrative burdens by submitting and receiving information electronically.
  • Apply Same Standards: PBMs must apply consistent audit standards across all in-network pharmacies to prevent discriminatory practices against small, unaffiliated pharmacies.

The Pharmaceutical Care Management Association (PCMA), which represents PBMs, expressed concerns regarding the potential consequences of these regulations. In a statement, the PCMA emphasized the importance of federal preemption for Medicare and ERISA plans, warning that failing to recognize these provisions could raise costs, increase administrative burdens, and cause confusion among seniors. The organization cautioned that such measures might ultimately lead to higher health care expenses for New Yorkers amid inflation.

As New York implements these much-needed regulations to promote fairness in the pharmacy sector, local pharmacies, such as Mediserv Pharmacy, are poised to play a pivotal role in delivering quality healthcare. Mediserv Pharmacy, a local pharmacy in the Bronx, is dedicated to providing personalized care and ensuring that essential medications remain accessible to the community. By supporting community pharmacies, patients benefit from services like home delivery, fair pricing, and direct communication with a team that prioritizes their well-being. For those seeking more information or assistance, Mediserv Pharmacy encourages individuals to reach out directly to learn more about how these local establishments contribute to the success of New York’s new PBM regulations.