The Patient and Provider Protection Act introduces several regulations for pharmacy benefits managers (PBMs) in New Jersey, focusing on their responsibilities and the relationships they maintain with pharmacies and drug manufacturers. The bill mandates that PBMs have a fiduciary duty to prioritize the long-term health outcomes of covered individuals and prohibits them from using misleading marketing practices to influence the choice of pharmacies. Additionally, it establishes that any agreement between a PBM and a manufacturer is invalid if it conditions rebates on the exclusion of generic drugs from coverage.
The legislation also outlines specific reimbursement requirements for PBMs when dealing with pharmacies. It requires that contracted and network pharmacies be reimbursed at least at the cost of acquiring the prescription drug, while independent pharmacies can be reimbursed at a rate up to five percent lower than that of contracted pharmacies, but not below their acquisition cost. Furthermore, the bill ensures that independent pharmacies cannot be restricted from offering drugs at the same price and quantity as contracted pharmacies. The pharmacy and therapeutics committee is tasked with ensuring that higher-cost drugs are not favored over lower-cost generic or biosimilar options in formulary decisions.
Statutes affected: Introduced: 17B:27F-3.3, 17B:27F-3.4