Expands pharmacy benefit management services to include the management or administration of benefits relating to durable medical equipment; defines "durable medical equipment"; relates to pharmacy or durable medical equipment provider audits by pharmacy benefit managers.
Summary
Bill A07357 seeks to amend the public health law and insurance law to expand the scope of pharmacy benefit management (PBM) services to include the management and administration of benefits related to durable medical equipment (DME). The bill defines DME and outlines the responsibilities of PBMs in relation to both prescription drugs and DME, ensuring that they cannot substitute or alter prescriptions without prescriber approval. Additionally, it establishes a process for appeals regarding pricing disputes and mandates transparency in the auditing processes of pharmacies and DME providers by PBMs.
Impact
The bill will significantly alter the regulatory landscape for pharmacy benefit managers in New York by explicitly including durable medical equipment in their purview. This change will require PBMs to adhere to new standards and practices regarding the management of DME, which could enhance patient access to necessary medical equipment and ensure fair pricing practices. Furthermore, the bill aims to protect pharmacies and DME providers from unfair audit practices and provides a clearer framework for resolving disputes over pricing.
Sentiment
The sentiment surrounding Bill A07357 appears to be generally supportive among healthcare advocates and providers who believe that expanding PBM responsibilities will improve patient care and access to medical equipment. However, there may be concerns from some PBMs about the increased regulatory burden and potential impacts on their operational practices.
Contention
Notable points of contention include the potential for increased costs for PBMs due to the expanded responsibilities and the implications for pricing structures in the healthcare market. Some PBMs may argue that the bill could lead to higher insurance premiums or reduced access to certain medications and equipment due to the increased regulatory oversight.
Same As
Expands pharmacy benefit management services to include the management or administration of benefits relating to durable medical equipment; defines "durable medical equipment"; relates to pharmacy or durable medical equipment provider audits by pharmacy benefit managers.