N.M. Stat. § 13-7-47
Calculating an enrollee's cost-sharing obligation for
prescription drug coverage.
A. When calculating an enrollee's cost-sharing obligation for covered prescription
drugs, pursuant to group health coverage, including any form of self-insurance, offered,
issued or renewed under the Health Care Purchasing Act, the insurer shall credit the
enrollee for the full value of any discounts provided or payments made by third parties
at the time of the prescription drug claim.
B. Beginning on or after January 1, 2024, an insurer shall not charge a different
cost-sharing amount for:
(1)
prescription drugs or pharmacy services obtained at a non-affiliated
pharmacy; or
(2)
administration of prescription drugs at different infusion sites; provided that
an insurer may communicate with an insured regarding lower-cost sites of service.
C. Beginning on or after January 1, 2024, an insurer shall not require an insured to
make a payment at the point of sale for a covered prescription drug in an amount
greater than the least of the:
(1)
applicable cost-sharing amount for the prescription drug;
(2)
amount an insured would pay for the prescription drug if the insured
purchased the prescription drug without using a health benefits plan or any other source
of prescription drug benefits or discounts;
(3)
total amount the pharmacy will be reimbursed for the prescription drug
from the insurer, including the cost-sharing amount paid by an insurer; or
(4)
value of the rebate from the manufacturer provided to the insurer or its
pharmacy benefits manager for the prescribed drug.
D. Beginning on or after January 1, 2024, if a prescription drug rebate is more than
the amount needed to reduce the insured's copayment to zero on a particular drug, the
remainder shall be credited to the insurer.
E. Beginning on or after January 1, 2024, any rebate amount shall be counted
toward the insured's out-of-pocket prescription drug costs.
F. For purposes of this section, "cost sharing" means any:
(1)
copayment;
(2)
coinsurance;
(3)
deductible;
(4)
out-of-pocket maximum amount;
(5)
other financial obligation, other than a premium or share of a premium; or
(6)
combination thereof.
G. The provisions of this section do not apply to excepted benefit plans as provided
pursuant to the Short-Term Health Plan and Excepted Benefit Act [Chapter 59A, Article
23G NMSA 1978], catastrophic plans, tax-favored plans or high-deductible health plans
with health savings accounts until an eligible insured's deductible has been met, unless
otherwise allowed pursuant to federal law.