HB 165 — PHARMACY PROVIDER REIMBURSEMENT

HOUSEAN BILLACT 165RELATING 56THTO LEGISLATUREPHARMACEUTICAL -DRUGS; STATEOFNEWMEXICO- SECOND SESSION , 2024 INTRODUCED BY Gail Armstrong and Tara Jaramillo This document may incorporate amendments proposed by a committee, but not yet adopted, as well as amendments that have been adopted during the current legislative session.

TheREQUIRING documentMEDICAID isMANAGED aCARE toolORGANIZATIONS toTO showREIMBURSE amendmentsCOMMUNITY-BASED inPHARMACY contextPROVIDERS andFOR cannotTHE beFULL usedCOST forOF thePRESCRIPTION purposeDRUGS ofPLUS addingA amendmentsPROFESSIONAL toDISPENSING legislation.FEE.

h7 ANBE ACTIT gENACTED oBY RELATINGTHE TOLEGISLATURE PHARMACEUTICALOF DRUGS;THE STATE OF NEW MEXICO:

REQUIRING MEDICAID MANAGED t hr g e i k CARE ORGANIZATIONS TO REIMBURSE COMMUNITY-BASED PHARMACY h r i s PROVIDERS FOR THE FULL COST OF PRESCRIPTION DRUGS PLUS A h , t, PROFESSIONAL DISPENSING FEE HAFCº ;

REQUIRING THE HEALTH CARE e u g e b l e e h AUTHORITY DEPARTMENT TO CONDUCT A STUDY TO DETERMINE AND SET A n d d i = = o h REASONABLE PROFESSIONAL DISPENSING FEE FOR PHARMACY PROVIDERS l ] b ,d i a º e THAT PROVIDE SERVICES TO MEDICAID RECIPIENTS;

MAKING AN r i = r t e w d m a n o APPROPRIATION»HAFC .

d m :

b e d s º o t n = .226982.3AIC February 10, 2024 (7:22pm) s k m e e a n e d r e l u [ A d BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

[NEW MATERIAL] COMMUNITY-BASED PHARMACY REIMBURSEMENT.-- A.

h g B.

HAFCºEachThe timeprofessional thatdispensing thefee departmentreimbursed issuesto acommunity-based opharmacy tproviders hrshall requestbe forno proposalsless forthan managed care organizations, the g e i k department shall conduct a study to determine a reasonable h r i s h professional dispensing fee thatreimbursed coversto thecommunity-based costspharmacy ofproviders dispensingfor ,covered t,outpatient edrugs uin g a prescription drug, including the costHB of165/a aPage pharmacist's1 emedicaid bfee-for-service lprogram. e e h professional services.

Until the department sets a reasonable n d d i = = o h l ] b ,d professional dispensing fee, the»HAFC HAFCºThe»HAFC i a º e r i = r professional dispensing fee reimbursed to community-based t e w d m a n o pharmacy providers shall be HAFCºequal to»HAFC HAFCºno less d m :

b e d s º o t n = .226982.3AIC February 10, 2024 (7:22pm) s k m e - 2 - e a n e d r e l u [ A d than»HAFC the professional dispensing fee reimbursed to community-based pharmacy providers for covered outpatient drugs in the medicaid fee-for-service program.

(b) located in the state or near the state border, if the border town is a primary source of prescription drugs for medicaid recipients residing in the h border area;

and g o t hr (c) not:

2) g e i k hospital-owned;

h r i s 4) an extension of a medical practice or special facility;

5) h , t, owned by a corporate chain of pharmacies with stores outside of e u g e b l e e h the state;

n d d i = = o h (2) "ingredient cost" means the actual amount l ] b ,d i a º e paid to a community-based pharmacy provider for a prescription r i = r t e w d m a n o drug, not including the professional dispensing fee or cost dsharing; m :

b(3) e"managed dcare sorganization" ºmeans oa tHB n165/a =Page .226982.3AIC2 Februaryperson 10,or 2024entity (7:22pm)eligible sto kenter minto erisk-based -prepaid 3capitation -agreements ewith athe ndepartment eto dprovide rhealth ecare land urelated [services; A d sharing;

(3) "managed care organization" means a person or entity eligible to enter into risk-based prepaid capitation agreements with the department to provide health care and related services;

and (7) "wholesale acquisition cost" means a h manufacturer's list price for a prescription drug sold to u » r wholesalers in the United States, not including discounts, t h g e l i rebates or reductions in price." h r i s HAFCº SECTION 2.

APPROPRIATION.--SevenEFFECTIVE millionDATE.--The fiveeffective hdate ,of ethe hprovisions hundredof thousandthis dollarsact ($7,500,000) is appropriatedJuly from1, the2024. t u g e b l e e , gh general fund to the health care authority department for n d d i = = o h expenditure in fiscal year 2025 to increase reimbursement for l ] b ,d i a º r community-based pharmacy provider services and to conduct a e r = t e w d m a n o study to determine a reasonable professional dispensing fee for d m :

bHB r165/a ePage t3 º25 o t n = .226982.3AIC February 10, 2024 (7:22pm) s k m e - 4 - e a n e d r e l u [ A d pharmacy providers.

Any unexpended or unencumbered balance remaining at the end of fiscal year 2025 shall revert to the general fund.»HAFC SECTION HAFCº3.»HAFC HAFCº2.»HAFC EFFECTIVE DATE.--The effective date of the provisions of this act is July 1, 2024.

- 5 - » g o » r h t i k l i g t h s , e h t l i w l b l e e , g n d l h = = b , a l º d i a r e r = , a t e d m a n o d m :

b r e t º o t n = .226982.3AIC February 10, 2024 (7:22pm) s k em e e a n e d r e l u [ A d