OSI is issuing this Bulletin to clarify the interpretation of NMSA 1978 § 59A-61-7, and to remind all PBMs that it remains illegal to charge pharmacies any claims adjudication fees, regardless of whether these fees are itemized in a contract. The Legislature enacted this section of the Pharmacy Benefits Manager Regulation Act to ban these fees, NMSA 1978 § 59A-61-7, on March 17, 2017, effective June 16, 2017. The section banned all claims adjudication fees, including fees for the “the receipt and processing of a pharmacy claim, [for] the development or management of a claim processing or adjudication network, or [for] participation in a claim processing or claim adjudication network.”

PBM Data Call Bulletin August 2023