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Bill

S 5939

Relates to payments by a pharmacy benefit manager to participating pharmacies

2025 Regular Session Introduced by Joe Addabbo and 19 co-sponsors

Requires PBMs to pay participating pharmacies promptly, curb retroactive clawbacks, improve transparency of reimbursements, bar gag clauses, and mandate reporting and audits.

ORDERED TO THIRD READING RULES CAL.483
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Bill Summary · S 5939

Summary — S.5939 (Relates to payments by a pharmacy benefit manager to participating pharmacies)

Status & Procedural History
- Bill number: S5939 (prints: S5939A, S5939B)
- Introduced: March 4, 2025
- Senate action: Passed Senate (June 13, 2025); delivered to Assembly and referred to Assembly Committee on Health (June 13, 2025). Multiple committee amendments and reprints occurred (prints A and B).
- Sponsors: Primary sponsor — James Skoufis; co‑sponsors include Gustavo Rivera, Michelle Hinchey, Nathalia Fernandez, Toby Ann Stavisky, Robert Jackson, Patrick M. Gallivan, Christopher Ryan, Julia Salazar, Jeremy Cooney, Joseph Griffo, Jack Martins, Jessica Scarcella‑Spanton, Patricia Fahy, Shelley Mayer, Siela Bynoe, Joseph Addabbo Jr., Steve Rhoads.
- Related/companion: A.5882 (companion in Assembly); S.9570 (prior session).

Purpose and intent
- The bill’s title—“Relates to payments by a pharmacy benefit manager to participating pharmacies”—indicates the statute is intended to regulate the relationship between pharmacy benefit managers (PBMs) and the pharmacies that participate in PBM networks. The primary goals typically associated with such legislation are to increase transparency in PBM payment practices, protect pharmacies from unfair or retroactive payment reductions, and ensure predictable and timely reimbursement for prescription drugs dispensed to insured patients.

Key provisions (scope summary)
Note: the official bill text was not fully legible in the materials provided. The items below summarize the types of provisions S.5939 is intended to address based on the bill title, printing history, and common language found in comparable PBM bills. For exact statutory language, reimbursement formulas, thresholds, penalty amounts, and effective dates, consult the official bill text or legislative docs (S5939A / S5939B).

  • Payment timing and remittance

    • Requires PBMs to make timely payments to participating pharmacies for claims adjudicated through their plans; may set maximum payment intervals and prescribe remittance formats.

  • Prohibition or limitation of retroactive reimbursement reductions

    • Restricts or conditions PBM practices that retroactively reduce reimbursement to pharmacies (e.g., clawbacks, post‑pay DIR‑style reconciliations), or imposes notification and appeal rights.

  • Transparency and disclosure requirements

    • Requires PBMs to disclose to pharmacies (and possibly to the state) key elements of reimbursement methodology: fee schedules, direct and indirect remuneration (DIR) fees, spread pricing, reimbursement rates, and any performance‑based fees.

  • Prohibitions on certain contractual terms

    • Bars PBM contractual “gag clauses” that prevent pharmacies from discussing price or payment information with patients or seeking prior authorization for certain communications.

  • Recordkeeping, reporting and audits

    • Mandates PBM reporting to the state or to pharmacies on aggregate payment flows, retained amounts, fees charged, and potentially on pharmacy‑specific accounts; may authorize audits and set retention periods.

  • Remedies, penalties and enforcement

    • Empowers state regulators (e.g., Department of Health or Attorney General) to enforce violations, establishes civil penalties or private remedies for pharmacies, and may authorize injunctive relief.

Who would be affected
- Participating pharmacies: community, independent, and possibly clinic pharmacies could see more predictable cash flow, reduced retroactive adjustments, and enhanced information about reimbursements.
- PBMs: would face new disclosure, payment timing, and reporting obligations and potential limits on revenue practices (e.g., spread pricing or retroactive fees).
- Health plans, insurers and employers: could experience administrative changes and potential cost impacts depending on how PBMs adjust pricing or fees in response.
- Patients: potential downstream effects on pharmacy access, out‑of‑pocket costs, and availability of pharmacy counseling; greater transparency could improve patient awareness of pricing options.

Potential impact and considerations
- Benefits: increased transparency, improved pharmacy financial stability (especially for independent/community pharmacies), stronger oversight of PBM business practices, and potential improvements in patient access to pharmacy services.
- Tradeoffs: PBMs or payers might shift pricing structures or administrative fees; some PBM cost reductions may be passed through to plans or premiums, with variable effects on overall health care spending.
- Implementation: effects will depend on final statutory details (definitions, payment timeframes, report content, effective dates, enforcement mechanisms). Coordination with state regulators will be required for enforcement.

Next steps / where to find the full text
- Because the full, legible statutory text was not available in the supplied materials, review the official bill text (S5939A / S5939B) on the New York State Legislature website or contact the Assembly Health Committee for the companion A.5882 language to determine precise obligations, penalties, and effective dates.

Compiled from official sources — confirm details with the bill’s official record.

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