This Act restructures the State Employee Benefits Committee into the State Employee Benefits Council and establishes 3 specialized working committees to assist the Council in managing contracted health services for State employees and eligible pensioners: the Clinical Evaluation Working Committee, the Policy and Planning Working Committee, and the Financial Evaluation Working Committee.
This Act outlines the composition and statutory duties of each working committee to increase transparency, reduce costs, and improve the value of the State's health-care insurance plan. It grants all working committees the shared authority to establish quality metrics, enter into confidentiality agreements with pharmacy benefits managers, and request audits to determine the actual cost of pharmaceuticals to the State.
Additionally, the Clinical Evaluation Working Committee is tasked with drafting health service agreements and managing the formulary. The Policy and Planning Working Committee is responsible for creating financial models using reference based pricing from Medicare reimbursement rates as a benchmark and requiring comprehensive financial disclosures from pharmacy benefits managers. The Financial Evaluation Working Committee is established to assess the financial implications of health policy and advise the Council.
Finally, this Act mandates strict independence requirements for individuals or entities contracted to perform audits or reviews, establishes statutory definitions for key pharmacy pricing terms, and eliminates the Retiree Healthcare Benefits Advisory Subcommittee. This Act is effective January 1, 2028.