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--- version:introduced version+++ version:(document, no version)@@ -1,234 +1,211 @@-HOUSE BILL 137--57th legislature - STATE OF NEW MEXICO - second session, 2026--INTRODUCED BY--Elizabeth "Liz" Thomson--AN ACT--RELATING TO OPIOIDS; REQUIRING RETAIL PHARMACIES TO KEEP STOCKS-OF CERTAIN TYPES OF DRUGS THAT TREAT OPIOID USE DISORDER;-REQUIRING WHOLESALE DRUG DISTRIBUTORS TO REPORT INSTANCES IN-WHICH THE DISTRIBUTORS DO NOT FILL ORDERS FOR BUPRENORPHINE-MADE BY RETAIL PHARMACIES; REQUIRING REPORTS; PROVIDING-PENALTIES; MAKING AN APPROPRIATION.--BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:-- SECTION 1. A new section of the New Mexico Drug, Device-and Cosmetic Act is enacted to read:-- "[NEW MATERIAL] BUPRENORPHINE STOCKING REQUIREMENTS.---- A. At least once every thirty days, a retail-pharmacy that stocks controlled substances shall compute the-retail pharmacy's minimum daily buprenorphine stocking-requirement by determining the average amount of buprenorphine-dispensed to ultimate users per day in the previous thirty-days, rounding to the nearest milligram. A retail pharmacy-that is not a community-based pharmacy shall maintain a stock-of buprenorphine sufficient to satisfy the minimum daily-buprenorphine stocking requirement, plus at least three-additional prescriptions for buprenorphine, including at least-one prescription for buprenorphine that is a buprenorphine-monoproduct and one prescription for buprenorphine that is a-buprenorphine-naloxone combination product. A retail pharmacy-that is a community-based pharmacy shall maintain a stock of-buprenorphine that is at least equal to either the pharmacy's-minimum daily buprenorphine stocking requirement plus one-additional prescription for buprenorphine or two prescriptions-for buprenorphine, whichever is greater. A retail pharmacy-that fails to satisfy the stocking requirements of this section-is not in violation of this section if the retail pharmacy-takes any of the following actions within three days of failing-to satisfy the stocking requirements:-- (1) ordering a replacement stock of-buprenorphine sufficient to satisfy the stocking requirements-of this section; or-- (2) requesting a wholesale drug distributor to-increase the retail pharmacy's allotment of buprenorphine, and:-- (a) once the wholesale drug distributor-approves the request, ordering a replacement stock of-buprenorphine within three days of receiving the approval; or-- (b) the wholesale drug distributor-denies the request.-- B. A retail pharmacy shall maintain records of the-retail pharmacy's minimum daily buprenorphine stocking-requirements. Records shall be maintained for a period of at-least three years from the date of the record and may be-inspected as required by authorized agents of the board.-- C. A wholesale drug distributor shall report to the-board on a monthly basis, in a form and manner prescribed by-the board, each instance in which the wholesale drug-distributor:-- (1) denied, in whole or in part, an order for-buprenorphine submitted by a retail pharmacy;-- (2) delayed an order for buprenorphine-submitted by a retail pharmacy due to the retail pharmacy's-threshold of buprenorphine; or-- (3) denied a request by a retail pharmacy to-increase the retail pharmacy's threshold of buprenorphine.-- D. A report submitted by a wholesale drug-distributor pursuant to this subsection shall include:-- (1) the name of the retail pharmacy affected;-- (2) the date on which the retail pharmacy-submitted the order for buprenorphine or requested an increase-to the retail pharmacy's threshold of buprenorphine;-- (3) the date on which the wholesale drug-distributor denied or delayed the retail pharmacy's order for-buprenorphine or denied the requested increase in the retail-pharmacy's threshold of buprenorphine;-- (4) the reason the wholesale drug distributor-denied or delayed the retail pharmacy's order for buprenorphine-or denied the requested increase in the retail pharmacy's-threshold of buprenorphine; and-- (5) any other information required by the-board.-- E. The board shall submit data gathered pursuant to-this section to the department of health. The department of-health shall analyze the data and publish a biannual report on-access to buprenorphine in retail pharmacies. The report shall-include:-- (1) information on the frequency with which-each wholesale drug distributor:-- (a) denied a retail pharmacy's order for-buprenorphine;-- (b) delayed a retail pharmacy's order-for buprenorphine due to the retail pharmacy's threshold of-buprenorphine; or-- (c) denied a retail pharmacy's requested-increase in the retail pharmacy's threshold of buprenorphine;-- (2) aggregated data on the reasons reported by-wholesale drug distributors for denying a retail pharmacy's-order for buprenorphine or a request by a retail pharmacy to-increase the retail pharmacy's threshold of buprenorphine; and-- (3) any other information that the department-of health deems appropriate.-- F. Reports published pursuant to Subsection E of-this section shall not include information that could identify-individual retail pharmacies and shall comply with state and-federal privacy and confidentiality laws, rules and-regulations.-- G. When the board or the department of health is-required by law, including the Inspection of Public Records-Act, to disclose information gathered pursuant to this section,-the board or the department of health shall redact information-gathered pursuant to Subsection C of this section that could-identify an individual retail pharmacy.-- H. The board may impose the following penalties on-retail pharmacies that violate this section:-- (1) for a first or second violation, notice of-the violation that includes information on the requirements to-comply with this section;-- (2) for a third violation within a thirty-six-month period, a directed plan of correction to help the retail-pharmacy remain compliant with the requirements of this-section; and-- (3) for a fourth violation or any subsequent-violation within a thirty-six-month period following the-previous violation, a fine not to exceed two thousand five-hundred dollars ($2,500).-- I. The board may impose the following penalties on-wholesale drug distributors that violate this section:-- (1) for a first violation, notice of the-violation that includes information on the requirements to-comply with this section; and-- (2) for a second violation or any subsequent-violation within a thirty-six-month period following the-previous violation, a fine not to exceed ten thousand dollars-($10,000).-- J. A retail pharmacy shall not be penalized for a-violation of this section if the violation is solely-attributable to the action of a wholesale drug distributor. A-retail pharmacy may conclusively establish that a violation of-this section is solely attributable to the action of a-wholesale drug distributor by demonstrating compliance with-Paragraph (1) or (2) of Subsection A of this section.-- K. As used in this section:-- (1) "buprenorphine" means the drug-buprenorphine, including any official, generic or chemical name-used to describe buprenorphine prescribed for the treatment of-opioid use disorder;-- (2) "community-based pharmacy" means a retail-pharmacy that is:-- (a) open to the public for prescriptions-to be filled, regardless of the facility or practice where the-prescription was written; and-- (b) not: 1) government-owned; 2)-hospital-owned; 3) owned by a corporation that owns hospitals;-4) an extension of a medical practice or special facility; 5)-owned by a corporate chain of pharmacies with stores outside of-the state; or 6) a mail-order pharmacy;-- (3) "minimum daily buprenorphine stocking-requirement" means the average number of milligrams of-buprenorphine dispensed to ultimate users by a retail pharmacy-per day over a thirty-day period, in formulations, dosages and-brand names consistent with the prescriptions for buprenorphine-dispensed to ultimate users by the retail pharmacy during the-thirty-day period;-- (4) "prescription for buprenorphine" means--sufficient buprenorphine in tablet or film form to provide a-patient with twenty-four milligrams per day for two weeks;-- (5) "retail pharmacy" means a pharmacy-physically located, and licensed to dispense drugs, in the-state;-- (6) "ultimate user" means a person who-lawfully possesses buprenorphine for the person's own use or-for the use of a member of the person's household; and-- (7) "wholesale drug distributor" means a-person licensed to engage in the wholesale distribution of-prescription drugs in the state."-- SECTION 2. APPROPRIATION.--One million five hundred-thousand dollars ($1,500,000) is appropriated from the general-fund to the health care authority for expenditure in fiscal-year 2027 to increase medicaid reimbursement rates for-buprenorphine prescriptions. Any unexpended balance remaining-at the end of fiscal year 2027 shall revert to the general-fund.--- 8 -+Fiscal impact reports (FIRs) are prepared by the Le gislative Finance Committee (LFC) for standing finance+committees of the Legislature. LFC does not assume responsibility for th e accuracy of these reports if they+are used for other purposes.++F I S C A L I M P A C T R E P O R T++BILL NUMBER: CS/House Bill 137/HHHCS+SHORT TITLE: Stocking of Certain Drugs in Pharmacies+SPONSOR: House Health and Human Services Committee+LAST+UPDATE:+ ORIGINAL+DATE:++2/5/2026++ANALYST: Chenier++APPROPRIATION*+(dollars in thousands)+FY26 FY27 Recurring or+Nonrecurring+Fund+Affected+ $1,500.0 Recurring General Fund+*Amounts reflect most recent analysis of this legislation.++ESTIMATED ADDITIONAL OPERATING BUDGET IMPACT*+(dollars in thousands)+Agency/Program FY26 FY27 FY28 3 Year+Total Cost+Recurring or+Nonrecurring+Fund+Affected+DOH $127.8 $127.8 $255.6 Recurring General Fund+Parentheses ( ) indicate expenditure decreases.+*Amounts reflect most recent analysis of this legislation.++Sources of Information++LFC Files++Agency or Agencies Providing Analysis+Department of Health+Health Care Authority+Regulation and Licensing Department++SUMMARY++Synopsis of the HHHC Substitute to House Bill 137++The House Health and Human Services Co mmittee substitute for House Bill 137+(HB137/HHHCS) appropriates $1.5 million from the genera l fund to the Health Care Authority+(HCA) to increase Medicaid reimbursement rates for buprenorphine prescriptions.++This bill aims to improve access to medications that treat opioid use disorder by ensuring that+pharmacies keep adequate supplies of buprenor phine, a key treatment drug. It requires+pharmacies to regularly calculate how much buprenorphine th ey dispense and to maintain a+minimum stock based on recent patient demand, with additional requirements depending on+whether the pharmacy is community-based or not. Pharmacies are given limited flexibility if they+temporarily fall below required stock levels, so long as they promptly reorder medication or seek+CS/House Bill 137/HHHCS – Page 2++higher distribution limits from wholesalers.++The bill also increases transparency and oversight of the drug supply chain by requiring+wholesale drug distributors to report when they deny or delay pharmacy orders for+buprenorphine or refuse to raise a pharmacy’s ordering threshold. These reports must include+reasons for the denial or delay and are submitted monthly to the state bo ard, which then shares+the data with the Department of Health (DOH) . DOH must analyze this information and publish+a public, twice-yearly report on statewide access to buprenorphi ne, while protecting pharmacy+identities and complying with privacy laws.++To enforce compliance, the bill establishes graduated penalties fo r both pharmacies and+wholesale distributors, beginning with notices and escalating to corrective plans and fines for+repeated violations. Pharmacies would be protected from penalt ies when shortages are caused+solely by distributor actions, provided they can show they followed required procedures.++The effective date of the provisions of this act is September 1, 2026.++FISCAL IMPLICATIONS++The appropriation of $1.5 million contained in this bill is a recurring expense to the general fund.+Any unexpended or unencumbered balance remaini ng at the end of FY27 shall revert to the+general fund.++DOH states the bill requires pharmacies to collect and report data on availability of specific+pharmaceuticals for treatment of opioid use disorder. This data would be reported to DOH for+analysis. DOH is required to prepare a biannual report. DOH estimates it would require one full-+time epidemiologist position to gather and anal yze data for this reporting requirement. The+current midpoint salary for ep idemiologists is $44.21 per hour or $91.9 thousand per year. With+benefits calculated at 39 percent, the total annual cost is $127.8 thousand. The legislation does+not create such a position nor provide any funding to the department; the appropriation would be+to the Health Care Authority (HCA).++HCA states currently Medicaid reimburses for medications using a standardized algorithm,+largely established by federal re gulations, that pays at the lowe st reference price (based on+industry standards) plus a dispensing fee of $10.30. Federal approval would be required to revise+the reimbursement methodology for buprenorphine; however, it is unlikely the federal Centers+for Medicare and Medicaid Services would allow HCA to reimburse buprenorphine prescriptions+in this fashion. An alternative model that incentivizes data reporting by pharmacies may be+easier to implement.++The Regulation and Licensing Department (RLD) st ates all employees assigned to fulfill the+duties of the Board of Pharmacy, administrativel y attached to RLD, are employed by RLD and+compensated through the RLD. The Board of Phar macy reports it expect s to incur additional+administrative expenses related to compliance and reporting obligations, with an estimated need+for an additional full-time inspector (at approximately $200 thousand per year) and an additional+administrative staff member (at approximately $80 thousand per year). HB137 does not dedicate+funding or personnel to the Board of Pharmacy/R LD to cover those new requirements. Funding+for operations of the Board of Pharmacy co mes from the pharmacy fund, a nonreverting fund+established by Section 61-11-19 NMSA 1978. A su fficient appropriati on from the pharmacy+CS/House Bill 137/HHHCS – Page 3++fund to RLD would be necessary each fiscal year to cover the increased staffing the Board of+Pharmacy would require if HB137 were enacted.++SIGNIFICANT ISSUES++DOH provides the following:+In 2024, the total number of drug overdose deaths in New Mexico was 746, with 64+percent (474 deaths) involvi ng opioids (nmhealth.org/data/v iew/substance/2889/). This+represented a decrease based on previous ye ars. However, based on recent provisional+CDC data, the number of overdose deaths in the state has recently begun to increase.++Adequate access to medication for opioid us e disorder (MOUD) remains a key barrier in+addressing this. In 2023, opioid overdose-rela ted visits accounted fo r 72 percent of all+drug overdose-related emergency visits. Desp ite the urgent need for treatment, many+individuals are unable to access the necessary medications . Local pharmacies in New+Mexico often report low to no stock of buprenorphine, a vital medication in MOUD,+leaving patients without consistent access to prescriptions. Nati onally, only 57.9 percent+of pharmacies reported havi ng buprenorphine/naloxone in st ock when requested, with+significant variability between states and pharmacy chains. New Mexicans face similar+challenges in getting their prescriptions filled (Source NM).++Limited access to treatment leads to lost productivity, premature death, and higher+healthcare costs due to both acute and chronic illnesses ( SAMHSA). Expanding+substance use disorder treatment services co uld yield positive econom ic benefits, reduce+criminal justice costs, and he lp lower criminal activity ( Science Direct). In 2021, one in+fourteen individuals in New Mexico needed treatment, but only one in seven sought help+due to barriers like stigma, limited availability, and eligibility restrictions.++Federal obstacles to bill implementation and reliable buprenorphine access++There have been significant e fforts by the state and healthcare sectors to improve access+to behavioral health and SUD treatment, but access to buprenorphine, considered the gold+standard for opioid use disord er treatment, has been unrelia ble. Removing barriers to+buprenorphine and promoting timely access to this medicine has been a stubborn problem+that states have had difficulty solving on their own.++Access to buprenorphine is primarily relate d to the SUPPORT Act, passed by Congress,+and several provisions of the master sett lement agreement (MSA) for the Opioid+Settlement. The SUPPORT Act was passed in an effort to monito r opioid distribution+through the establishment of the suspicio us order reporting system (SORS), which+requires all [Drug Enforcement Agency (DEA)] registrants that distribute controlled+substances to report suspicious orders to the DEA.++The relevant DEA regulations do not establish thresholds, nor do they require registrants+to set thresholds or limits on controlled substance orderi ng. The DEA does not exclude+medications for treatment of opioid use di sorder from the require ments. Buprenorphine+occupies a counterintuitive space because, while it shares a classification with opioids at+the center of the addiction and overdose crisis, it is the gold standard for treatment and+the long-term management of addiction.+CS/House Bill 137/HHHCS – Page 4++The DEA does not have requirements in place to ensure pharmacies are able to receive+adequate supplies to fill legitimate prescriptions.++The MSA for the Opioid Settlement impos es additional require ments on wholesale+pharmacy distributors to place ordering limits on retail pharmacies. These include the use+of data-driven systems to flag orders that exceed established thresholds. Once flagged,+these orders are automatically cancelled. The manner of determining medication+thresholds is proprietary information. If a pharmacy places an order exceeding its+threshold, the distributors may cancel the order and potentially report the order as+“suspicious” to state and federal law enforc ement. Moreover, the settlement agreement+prohibits distributors from informing individual pharmacies of their specific threshold+levels, how they are calculate d, or when existing orders a pproach them. This limits a+pharmacy’s ability to proactiv ely request an increase to it s buprenorphine threshold to+ensure it can meet local needs. Wholesaler s are prohibited from disclosing the algorithms+used to determine the thres holds, which would help retail pharmacies avoid overstepping+thresholds and triggering cancellations an d audits. While the MSA allows for the+temporary suspension of these thresholds during declared emergencies—such as the+current national emergency related to fentan yl—wholesale distributors have not applied+this provision to temporarily lift the thresholds for buprenorphine.++TECHNICAL ISSUES++DOH provides the following:+This bill mandates that retail pharmacies calculate the minimum daily buprenorphine+stocking requirement by dete rmining the average amount of buprenorph ine dispensed to+ultimate users per day in the previous 30 days, rounding to the ne arest milligram. Retail+pharmacies typically inventory based off of dispensing units (tablets/films etc).+Amending language from nearest milligram to dispensing unit would be easier for+pharmacies to implement.++Amend the definition of communi ty-based pharmacy so that there is not undue hardship+on locally owned independent pharmacies (as chain pharmacies, mail order pharmacies,+hospital pharmacies etc. are excluded) OR remove pharmacy stocking requirements and+penalties and leave only wholesale distribu tor reporting requirements in place. The+current definition of community-based pharmacy has the potential to hinder independent+pharmacy success and create a disadvantaged playing field for small business in New+Mexico. The language in essence target s only independent pharmacies as chain+pharmacies, mail order pharmacies, and hospital pharmacies are excluded from additional+recordkeeping requirements, greater cost of staffing to meet th ese requirements, and+penalties. Independent pharmacies will be at a disadvantage compared to their+competitors who are excluded from the bill . New Mexico has the 2nd highest pharmacy+shortage and many independent pharmacie s are struggling due to decreased PBM+reimbursement and preferred network inclusion.++EC/sgs/dw/ct/hg
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