PAWNY/PSSNY Legislative Priorities 2026
Patient Access to Pharmacy Act A5882 (McDonald) / S5939 (Skoufis)
Requires a pharmacy benefit manager (PBM) to pay a participating pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under NYS Medicaid.
Currently, pharmacies are paid below-cost for dozens of common medications, including inhalers, blood thinners, and pain management medication. The State implemented this simple reform to their Medicaid program, and realized $600M in savings since 2022. We believe commercial plans and patients can expect similar savings under this legislation. This legislation enacts a minimum reimbursement for at least the cost of the drug so pharmacies are not asked to dispense life-saving medications at a financial loss. Without this correction, NYS pharmacies will continue to close and pharmacy deserts widen.
Increase in Medicaid Rate
This ask is to include a Medicaid pharmacy dispensing-fee cost-of-living adjustment (COLA) in the budget.
New York has not adjusted the Medicaid pharmacy dispensing fee in eight years. A COLA is urgently needed to reflect current operational costs. A COLA is not a program expansion; it simply modernizes reimbursement to reflect economic reality.
NYSHIP Increase Direct to Pharmacies
This ask is to ensure the New York State Health Insurance Plan (NYSHIP) increase flows directly to pharmacies.
The Governor’s Executive Budget includes a 5.6% increase for NYSHIP. It is essential to the survival of community pharmacies that this increase flows directly to frontline pharmacies and is not absorbed by PBMs or other intermediaries.
A balanced strategy of commercial reform, Medicaid modernization, and fair NYSHIP reimbursement will protect patient access without raising patient costs.
OMIG Reform A1069-A (Paulin) / S4955-A (Harckham)
Pharmacists and pharmacies are united with the rest of the medical community in support of common-sense reforms to the State’s Office of the Medicaid Inspector General. This bill preserves OMIG’s audit authority, but reigns in excessive and punitive fines for paperwork errors.
Ban on PBM Ownership of Pharmacies A6546 (Steck) / (Senator Ryan to Introduce)
Prohibits the ownership, operation or control of pharmacies by pharmacy benefit managers. This eliminates conflicts of interest, ensures fair competition, and protects patients from steering and limited choice.
Test and Treat Expansion (A2534/S4501)
Authorizes pharmacists to provide front-line care through testing and treatment. Provides for the initiation of treatment for COVID-19, influenza, and pharyngitis resulting from a Group A streptococcal infection by a licensed pharmacist in certain circumstances.