Healthcare (Prescription Drugs)

Relates to directing the department of health to remove the pharmacy benefit from the managed care benefit package; provides the pharmacy benefit under the fee for service program.

This bill caps payments to pharmacies for certain high-cost drugs. It requires that pharmacies receive no more than 2.5% of a drug’s total cost (including federal benchmark pricing) plus any authorized dispensing fees, but only for drugs with a federal cost benchmark exceeding $670. The rule directly affects pharmacies dispensing these specific high-cost medications under New York’s Medicaid program. It aims to standardize reimbursement without altering existing dispensing fee structures.