NCPA provides PBM regulatory recommendations to New York

NCPA August 5, 2022

Earlier this summer, the New York State Department of Financial Services’ Pharmacy Benefits Bureau released multiple requests for information on how to best implement rules relating to the regulation of PBMs, as well as the application of existing laws to PBMs operating in New York. This bureau is a newly created entity in New York tasked with oversight and regulation of PBMs. Because state actions AFTER the passage of legislation are vitally important, NCPA responded to several of the RFIs. First, NCPA provided comments on the duty, accountability, and transparency of PBMs to health plans under NY Public Health Law Section 280-a(2). The comments can be found here.

Secondly, NCPA provided guidance on the application of state insurance laws to PBMs administering benefits to Medicare Part D plans. This is extraordinarily important because states are just beginning to realize their authority to regulate PBMs administering Part D plans, as that authority was confirmed in PCMA v. Wehbi  (8th Circuit Court of Appeals) late last year. The comments can be found here.

Finally, NCPA will be submitting comments on how the N.Y. Pharmacy Benefits Bureau should exercise its rulemaking authority to address patient steering by PBMs. Those comments are due Aug. 17 ,so stay tuned.