The "Ensuring Fairness in Cost-Sharing Amounts Act of 2024" aims to ensure that third-party discounts and payments are credited towards the out-of-pocket costs, such as copayments, coinsurance, and deductibles, for individuals covered by health benefits plans in New Jersey. The bill mandates that health insurance carriers and pharmacy benefits managers must account for any discounts or payments made by third parties when calculating an enrollee's financial responsibility for covered benefits. This requirement applies to all health care services under health benefits plans, including those administered by pharmacy benefits managers, and is particularly relevant for high-deductible health plans, where specific federal guidelines must be followed.

Additionally, the bill amends existing regulations governing pharmacy benefits managers to expand the scope of their services and redefine what constitutes cost-sharing. It prohibits these entities from altering health benefits plan coverage based on the availability of financial assistance for prescription drugs. By December 31 each year, carriers and pharmacy benefits managers must certify compliance with these requirements to the Commissioner of Banking and Insurance. This legislation aligns New Jersey with other states that have enacted similar measures to protect consumers from the exclusion of third-party assistance in calculating their health care costs. The bill is set to take effect on January 1, 2025.

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