This bill establishes new audit and payment requirements for pharmacy benefit managers (PBMs) in New Jersey. It mandates that PBMs must ensure that within 14 calendar days of receiving a pharmacy claim, either the claim is paid or reimbursed, or the pharmacy is notified in writing or electronically if the claim is contested or denied. Additionally, the bill amends existing law to require that PBMs maintain a procedure for timely updates to drug pricing information and provide an internal appeal mechanism for disputes regarding maximum allowable costs.

Furthermore, the bill enhances the auditing capabilities of health benefits plans, allowing them to access all relevant data related to prescription drug benefits administered by PBMs. It requires PBMs to provide records and data for inspection by the Department of Banking and Insurance annually, while ensuring that such information remains confidential and protected from public disclosure. The bill also introduces civil penalties for unauthorized disclosure of this information, reinforcing the accountability of PBMs in their operations.

Statutes affected:
Introduced: 17B:27F-2, 17B:27F-9.1