New York's financial services watchdog is accepting public comments through Feb. 16 on proposed pharmacy benefit manager regulations that are intended to strengthen consumer protections and address anti-competitive conduct.

The proposed set of rules follows New York's enactment of a 2021 law that is aimed at rooting out the former common practice of spread-pricing, which enables PBMs to charge pharmacists higher prices than they pay to manufacturers, yielding additional unknown profits.

  • Prohibit PBMs from barring any in-network pharmacies from providing mail order or delivery services;
  • Increase transparency to consumers and employers by requiring PBMs to list formularies and pharmacy directories online and prohibiting PBMs from punishing a consumer who relies on said information;
  • Require PBMs to post a telephone number and email address for consumers to direct their questions to, and PBMs must respond in a reasonable amount of time;
  • Prohibit anti-competitive practices that steer consumers away from their community pharmacy to larger pharmacies affiliated with the PBM;
  • Prohibit PBMs from unfairly passing losses onto pharmacies when the PBM mistakenly approved dispensing a drug and then seeks to retroactively deny reimbursement to the pharmacy;
  • Reduce administrative burdens and costs on small pharmacies by allowing them to submit information to and receive information from PBMs electronically;
  • Prevent the abuse of audits against small pharmacies who are not affiliated with a PBM by requiring PBMs to apply the same audit standards across all in-network pharmacies.

"It is no coincidence that as New Yorkers continue to pay more for life-saving medication each year, the PBM industry records billions in revenue with little regulatory oversight," Harris said in a statement. "This proposed regulation seeks to put an end to unfair practices by the PBM industry, making prescription drugs more affordable and accessible for New Yorkers."

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Brian Lee

Brian Lee is an Albany-based litigation reporter for the New York Law Journal. He has worked at daily newspapers in Massachusetts, New York and New Jersey. He can be reached at [email protected]. Twitter: @bleereporter