State Tracker Updated June 15, 2026

New Mexico: what the PBM reimbursement law requires

New Mexico requires PBM reimbursement to rest on objective, verifiable sources and to be no less than what the PBM pays its own affiliate for the same service, plus MAC-list transparency and an appeal with a 21-business-day filing window. It is a transparency-and-anti-self-dealing regime, not a NADAC-plus-fee floor.

Status	Partially enacted
Law	§ 59A-61-4 NMSA 1978, as amended by SB 14 (2023)
Effective date	July 1, 2023
Reimbursement basis	Reimbursement must be based on objective, verifiable sources and no less than what the PBM pays its own affiliate; no NADAC or acquisition-cost floor
Professional dispensing fee	Not specified in statute
Appeal route	Pharmacy has at least 21 business days to file an appeal; PBM must act in writing within 14 business days (deemed granted if no response); MAC lists updated at least every 7 business days

New Mexico’s § 59A-61-4 requires that a PBM set reimbursement “based on objective and verifiable sources” and pay a pharmacy no less than it pays its own affiliate for the same service — an anti-self-dealing parity rule rather than a cost-based floor. The 2023 amendment (SB 14) broadened the law from generic drugs to all drugs.

The statute layers on MAC-list transparency, updated at least every 7 business days, and an appeal with a generous 21-business-day filing window and a 14-business-day PBM response, after which the appeal is deemed granted. It does not require reimbursement at NADAC or above acquisition cost.

Sources

SB 14 (2023), enrolled bill (amends § 59A-61-4) — New Mexico Legislature Primary source

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