Pharmacy Benefit Managers (“PBMs”) in New York are expected to begin issuing “Notices of Non-Renewal”. These notices may also be accompanied by purported “for-cause termination” notices seeking to remove or terminate pharmacies from their pharmacy networks for the upcoming 2025 year. When asserting a non-renewal, PBMs may attempt to rely on a provision of New York Public Health Law (“PHL”) § 4406-d that references the notion of non-renewal rights that can occur at the beginning of each calendar year. However, the application of this provision of the PHL as to PBMs is questionable, and also carries with it certain notice requirements. Among these, the PHL requires at least 60 days’ notice before the “non-renewal” can take effect—in fact, failure to provide the requisite notice alone may render such non-renewals unenforceable.
While New York’s PHL is a state-based provision, providers should keep in mind that Medicare’s Any Willing Provider Law prohibits a PBM from terminating a pharmacy’s Medicare Part D line of business without cause or taking action akin to a non-renewal. Various laws at both the federal and state level protect pharmacies against this type of conduct by PBMs. With this information, if you have received a “Notice of Non-Renewal” from your PBM or any other correspondence related to a possible termination, you may be able to challenge the PBM’s actions and conduct, and should be proactive in doing so.
How Frier Levitt Can Help
Frier Levitt represents numerous pharmacies across the United States and has assisted New York Pharmacies in challenging PBMs “Notice of Non-Renewal” and “for-cause terminations”. Contact us to speak with an attorney about how your pharmacy can leverage the protections afforded by your state’s laws governing PBMs.
