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 modifies the definition of "cost-sharing amount" to encompass a broader range of charges required of covered persons for health care services. The bill also establishes annual certification requirements for carriers and pharmacy benefits managers to ensure compliance with these provisions. By implementing these changes, New Jersey aligns itself with a growing trend among states to enhance consumer protections in health insurance and ensure that individuals can benefit from third-party financial assistance in managing their healthcare costs.

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