SENATE BILL 62

57th legislature - STATE OF NEW MEXICO - first session, 2025

INTRODUCED BY

Elizabeth "Liz" Stefanics and Elizabeth "Liz" Thomson

 

 

 

FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE

 

AN ACT

RELATING TO PHARMACEUTICAL BENEFITS; AMENDING THE PHARMACY BENEFITS MANAGER REGULATION ACT TO RESTRICT THE TYPES OF FEES THAT PHARMACY BENEFITS MANAGERS CAN COLLECT; DECLARING CERTAIN ACTIONS MADE BY PHARMACY BENEFITS MANAGERS AS UNFAIR OR DECEPTIVE TRADE PRACTICES.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. Section 59A-61-2 NMSA 1978 (being Laws 2014, Chapter 14, Section 2, as amended) is amended to read:

     "59A-61-2. DEFINITIONS.--As used in the Pharmacy Benefits Manager Regulation Act:

          A. "bona fide service fee" means a fee charged by a pharmacy benefits manager that is:

                (1) a flat dollar amount;

                (2) consistent with fair market value; and

                (3) solely related to the provision of pharmacy benefits management services;

          B. "conflict of interest" means a situation in which a pharmacy benefits manager or pharmacy benefits manager affiliate derives any kind of remuneration, other than the collection of a bona fide service fee, from providing pharmacy benefits management services;

          [A.] C. "maximum allowable cost" means the maximum amount that a pharmacy benefits manager will reimburse a pharmacy for the cost of a generic drug;

          [B.] D. "maximum allowable cost list" means a searchable, electronic and internet-based listing of drugs used by a pharmacy benefits manager setting the maximum allowable cost on which reimbursement to a pharmacy or pharmacist is made;

          [C.] E. "obsolete" means a product that is listed in national drug pricing compendia but is no longer available to be dispensed based on the expiration date of the last lot manufactured;

          [D.] F. "pharmacist" means an individual licensed as a pharmacist by the board of pharmacy;

          [E.] G. "pharmacy" means a licensed place of business where drugs are compounded or dispensed and pharmacist services are provided;

          [F.] H. "pharmacy benefits management" means a service provided to or conducted by a health plan as defined in Section 59A-16-21.1 NMSA 1978, [or] health insurer or other third party that involves:

                (1) prescription drug claim administration;

                (2) pharmacy network management;

                (3) negotiation and administration of prescription drug discounts, rebates and other benefits;

                (4) design, administration or management of prescription drug benefits;

                (5) formulary management;

                (6) payment of claims to pharmacies for dispensing prescription drugs;

                (7) negotiation or administration of contracts relating to pharmacy operations or prescription benefits; or

                (8) any other service determined by the superintendent as specified by rule to be a pharmacy benefits management activity;

          [G.] I. "pharmacy benefits manager" means an entity that provides pharmacy benefits management services;

          [H.] J. "pharmacy benefits manager affiliate" means a pharmacy or pharmacist that directly or indirectly, through one or more intermediaries, owns or controls, is owned or controlled by or is under common ownership or control with a pharmacy benefits manager;

          [I.] K. "pharmacy services administrative organization" means an entity that contracts with a pharmacy or pharmacist to act as the pharmacy or pharmacist's agent with respect to matters involving a pharmacy benefits manager or third-party payor, including negotiating, executing or administering contracts with the pharmacy benefits manager or third-party payor; and

          [J.] L. "superintendent" means the superintendent of insurance."

     SECTION 2. Section 59A-61-3 NMSA 1978 (being Laws 2014, Chapter 14, Section 3, as amended) is amended to read:

     "59A-61-3. LICENSURE--INITIAL APPLICATION--ANNUAL RENEWAL REQUIRED--REVOCATION.--

          A. A person shall not operate as a pharmacy benefits manager or provide pharmacy benefits management services unless licensed by the superintendent in accordance with the Pharmacy Benefits Manager Regulation Act and applicable federal and state laws. A licensee shall renew the licensee's pharmacy benefits manager license annually.

          B. An initial application and a renewal application for licensure as a pharmacy benefits manager shall be made on a form and in a manner provided for by the superintendent, but at a minimum shall require:

                (1) the identity of the pharmacy benefits manager;

                (2) the name and business address of the contact person for the pharmacy benefits manager;

                (3) where applicable, the federal employer identification number for the pharmacy benefits manager; and

                (4) any other information specified in rules promulgated by the superintendent.

          C. The superintendent shall enforce and promulgate rules to implement the provisions of the Pharmacy Benefits Manager Regulation Act and may suspend or revoke a license issued to a pharmacy benefits manager or deny an application for a license or renewal of a license if:

                (1) the pharmacy benefits manager is operating in contravention of its application;

                (2) the pharmacy benefits manager has failed to continuously meet or comply with the requirements for issuance or maintenance of a license; [or]

                (3) the pharmacy benefits manager has a conflict of interest; or

                [(3)] (4) the pharmacy benefits manager has failed to comply with applicable state or federal laws or rules.

          D. If the license of a pharmacy benefits manager is revoked, the pharmacy benefits manager shall proceed, immediately following the effective date of the order of revocation, to conclude its affairs, notify each pharmacy in its network and conduct no further pharmacy benefits management services in the state, except as may be essential to the orderly conclusion of its affairs. The superintendent may permit further operation of the pharmacy benefits manager if the superintendent finds it to be in the best interest of patients. A pharmacy benefits manager's failure to comply with the superintendent's order to conclude the pharmacy benefits manager's affairs shall constitute an unfair or deceptive trade practice pursuant to the Unfair Practices Act.

          E. A person whose pharmacy benefits manager license has been denied, suspended or revoked may seek review of the denial, suspension or revocation pursuant to the provisions of Chapter 59A, Article 4 NMSA 1978.

          F. Nothing in the Pharmacy Benefits Manager Regulation Act shall be construed to authorize a pharmacy benefits manager to transact the business of insurance."

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