Bill Text: NJ S3929 | 2018-2019 | Regular Session | Introduced
Bill Title: Requires pharmacy benefits manager providing services within Medicaid program to disclose certain information to DHS.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2019-06-13 - Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee [S3929 Detail]
Download: New_Jersey-2018-S3929-Introduced.html
Sponsored by:
Senator TROY SINGLETON
District 7 (Burlington)
SYNOPSIS
Requires pharmacy benefits manager providing services within Medicaid program to disclose certain information to DHS.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning pharmacy benefits managers providing services within the Medicaid program and supplementing Title 30 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Any contract or other arrangement entered into by a managed care organization that has contracted with the Division of Medical Assistance and Health Services in the Department of Human Services to provide benefits under the Medicaid Program for the provision of pharmacy benefits management services shall require the pharmacy benefits manager to disclose to the department:
(1) all sources and amounts of income, payments, and financial benefits received by the pharmacy benefits manager in relation to the provision and administration of pharmacy benefits management services on behalf of the managed care organization, including, but not limited to, any pricing discounts, rebates of any kind, inflationary payments, credits, clawbacks, fees, grants, chargebacks, reimbursements, or other benefits;
(2) all ingredient costs and dispensing fees or similar payments made by the pharmacy benefits manager to any pharmacy in connection with the contract or other arrangement; and
(3) the pharmacy benefits manager's payment model for administrative fees.
b. As used in this section:
"Pharmacy benefits manager" means a corporation, business, or other entity, or unit within a corporation, business, or other entity, that administers prescription drug benefits on behalf of a managed care organization.
"Pharmacy benefits management services" mean the provision of any of the following services on behalf of a managed care organization: the procurement of prescription drugs at a negotiated rate for dispensation within this State; the processing of prescription drug claims; or the administration of payments related to prescription drug claims.
2. The Commissioner of Human Services, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations necessary to implement the provisions of this act.
3. This act shall take effect immediately.
STATEMENT
This bill requires a pharmacy
benefits manager providing
services within Medicaid program to disclose certain information to the
Department of Human Services. It is the sponsor's goal that such transparency
will help the State to assess the magnitude in which pharmacy benefits managers
engage in spread pricing. Spread pricing means any amount charged or claimed
by a pharmacy benefits manager in excess of the amount paid to a pharmacy on
behalf of a managed care organization, less an administrative fee. Studies in
other states have estimated that prohibiting spread pricing could save Medicaid
programs up to $43 million annually.
Under this bill, any contract or other arrangement entered into by a managed care organization that has contracted with the Division of Medical Assistance and Health Services in the Department of Human Services to provide benefits under the Medicaid Program for the provision of pharmacy benefits management services would require the pharmacy benefits manager to disclose to the department:
(1) all sources and amounts of income, payments, and financial benefits received by the pharmacy benefits manager in relation to the provision and administration of pharmacy benefits management services on behalf of the managed care organization, including, but not limited to, any pricing discounts, rebates of any kind, inflationary payments, credits, clawbacks, fees, grants, chargebacks, reimbursements, or other benefits;
(2) all ingredient costs and dispensing fees or similar payments made by the pharmacy benefits manager to any pharmacy in connection with the contract or other arrangement; and
(3) the pharmacy benefits manager's payment model for administrative fees.
As defined in the bill, a "pharmacy benefits manager" means a corporation, business, or other entity, or unit within a corporation, business, or other entity, that administers prescription drug benefits on behalf of a managed care organization. "Pharmacy benefits management services" is further defined to mean the provision of any of the following services on behalf of a managed care organization: the procurement of prescription drugs at a negotiated rate for dispensation within this State; the processing of prescription drug claims; or the administration of payments related to prescription drug claims.
