2026 Budget & Policy Priorities

1.  Patient Access to Pharmacy Act (PAPA) - A5882 (McDonald) / S5939 (Skoufis)

Requires a pharmacy benefit manager (PBM) to pay pharmacies the Medicaid Rate in commercial plans. 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.

2.  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.

3.  Increase in Medicaid Reimbursement Rate

Pharmacies receive a flat dispensing fee of $10.18 per prescription.  That fee was set in statute based on a 2016 Cost of Dispensing survey conducted by Myers & Stouffer.  Despite inflation and increased minimum wage pressures, the fee has not been adjusted.  Using the U.S. Department of Labor’s inflation calculator, that $10.18 is equivalent to $13.17 today.  This simple cost of living adjustment is the bare minimum that pharmacies deserve.

4.  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.

 5.  Expanded Pharmacy Services  - A2534 (McDonald) / S4501 (Rivera) & A3285 (McDonald) / S1619 (Rivera)

These bills authorize pharmacists to test for common ailments, and then dispense routine medication under a protocol developed by the Commissioner of Health.  This leads to increased access to care, and diverts minor ailments away from hospital emergency rooms.

* NYSHIP Reimbursement Reform*

New York State’s NYSHIP program reimburses pharmacies below their actual cost to dispense medications, creating unsustainable financial strain for our stores.  The State’s PBM contract promised savings, but the Executive Budget proposed a 5.6% increase in funding due to NYSHIP prescription drug costs.  The State must take the lead on fairness and pushing back against PBM abuses, by reforming their subcontractor’s practices.