Requires the amount paid to a pharmacy for certain high cost drugs be no more than 2.5% of the total cost of such drug plus any dispensing fees.
Summary
Bill S06323 seeks to amend the social services law in New York by establishing a cap on the amount that can be reimbursed to pharmacies for high-cost drugs. Specifically, the bill stipulates that if a drug's national average acquisition cost exceeds $670, the reimbursement to the pharmacy will be limited to no more than 2.5% of the total cost of the drug, in addition to any authorized dispensing fees. This change aims to control pharmacy costs associated with high-cost medications and ensure that reimbursement rates remain manageable for the state’s budget.
Impact
If enacted, this bill will significantly alter the reimbursement structure for pharmacies dispensing high-cost drugs under the social services law. It will limit the financial compensation pharmacies receive, potentially impacting their profit margins and operational viability, especially for those that rely heavily on dispensing high-cost medications. The bill may also influence the availability of certain medications in the market, as pharmacies might reconsider stocking high-cost drugs due to reduced profitability.
Sentiment
The sentiment surrounding Bill S06323 appears to be mixed, with some stakeholders supporting the need for cost control in healthcare, while others express concerns about the potential negative impact on pharmacies and patient access to necessary medications. The lack of voting history suggests that the bill is still in the early stages of discussion, and further debate may clarify the positions of various stakeholders.
Contention
Notable points of contention include the balance between controlling healthcare costs and ensuring that pharmacies remain financially viable. Supporters argue that the bill is necessary to prevent excessive spending on high-cost drugs, while opponents, including some pharmacy representatives, fear that the reimbursement cap may lead to reduced access to medications and financial strain on pharmacies, particularly in underserved areas.
Requires a pharmacy benefit manager to pay a participating pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under the state medical assistance program.
Requires a pharmacy benefit manager to pay a participating pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under the state medical assistance program.