The proposed bill, known as the Ensuring Fairness in Cost-Sharing Amounts Act of 2024, aims to prohibit health insurance carriers and pharmacy benefits managers in New Jersey from utilizing accumulators that disregard third-party discounts and payments. Specifically, the bill mandates that when calculating an enrollee's cost-sharing amounts—such as copayments, coinsurance, and deductibles—carriers and pharmacy benefits managers must give credit for any amounts paid by third parties. This requirement applies to all health benefits plans, including high-deductible health plans, and ensures that individuals receive appropriate credit for financial assistance they receive for their out-of-pocket costs.

Additionally, the bill amends existing regulations concerning pharmacy benefits managers to expand the scope of their services and redefine what constitutes cost-sharing. Notably, it clarifies that cost-sharing includes any charges required of a covered person for health care services, including prescription drugs. The bill also establishes annual certification requirements for carriers and pharmacy benefits managers to confirm compliance with these provisions. By implementing these changes, New Jersey aligns itself with a growing trend across the U.S. to enhance transparency and fairness in health care cost-sharing practices. The bill is set to take effect on January 1, 2025.

Statutes affected:
Introduced: 17B:27F-1