Sponsored by:
Senator JOSEPH F. VITALE
District 19 (Middlesex)
SYNOPSIS
Requires cost sharing amounts for certain prescription drug benefits to be based on final cost to carrier.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning prescription drug benefits and supplementing P.L.2015, c.179 (C.17B:27F-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A carrier shall base any cost sharing required to be paid by a covered person for a prescription drug on the final amount paid for the prescription drug by the carrier, after:
(1) any price negotiation by the carrier or a pharmacy benefits manager under contract with the carrier; or
(2) the deduction of any compensation remitted by or on behalf of a pharmaceutical manufacturer, developer, or labeler, directly or indirectly, to the carrier or to a pharmacy benefits manager under contract with the carrier.
b. As used in this section:
Carrier means an insurance company, health service corporation, hospital service corporation, medical service corporation, prepaid prescription service organization, or health maintenance organization authorized to issue health benefits plans in this State. Carrier shall also include the State Health Benefits Program and the School Employees' Health Benefits Program.
"Compensation" means any direct or indirect financial benefit, including, but not limited to, rebates, discounts, credits, fees, grants, chargebacks or other payments or benefits of any kind, that is attributed to, directly or indirectly, the utilization of a health benefits plan or enrollment in a health benefits plan, regardless of how the benefits are otherwise characterized by a carrier or pharmacy benefits manager and relevant third parties.
2. This act shall take effect immediately and shall apply to health benefits plans issued or renewed on or after January 1 of the next calendar year following the date of enactment.
STATEMENT
This bill requires the cost sharing amounts for certain prescription drug benefits to be based on the final cost of those prescription drugs to the carrier.
Specifically, the bill requires carriers to base any cost sharing required to be paid by a covered person for a prescription drug on the final amount paid for the prescription drug by the carrier, after:
(1) any price negotiation by the carrier or a pharmacy benefits manager under contract with the carrier; and
(2) the deduction of any compensation remitted by or on behalf of a pharmaceutical manufacturer, developer, or labeler, directly or indirectly, to the carrier or to a pharmacy benefits manager under contract with the carrier.
As used in the bill, carrier includes the various entities licensed by the State to provide health insurance, as well as the State Health Benefits Program and the School Employees' Health Benefits Program.