Bill > A5341

Introduced Session

This bill establishes a three-year Medicaid demonstration project to pay for certain drugs according to outcome-based system. Under the bill, the Department of Human Services will establish a three-year demonstration project to employ outcome-based payment systems for a limited number of prescription drugs covered under the program. The department will enter into purchasing or rebate agreements with the manufacturers of at least three different prescription drugs, which will provide that the total reimbursement paid by the State for such drugs will be based in some part on observed outcomes of the drug's use in patients. The drugs selected for the demonstration program will have specific therapeutic purposes with outcomes that are readily measurable with existing data systems, and will be among the highest-cost drugs in the New Jersey Medicaid program in aggregate spending. The department and the manufacturer of each drug selected for the program must agree to specific performance targets, methods of monitoring performance, and other relevant factors in the design of the demonstration program. The department will require that Medicaid managed care organizations participate in the demonstration program, and will specify the obligations of the managed care organizations under the demonstration program in the contract between the department and the managed care organizations. After the expiration of the three-year demonstration project, the Commissioner of Human Services will report to the Governor and Legislature on the results of the demonstration project, along with the commissioner's recommendations to expand, revise, or discontinue the demonstration project. The report shall include specific performance test results, aggregated and de-identified as necessary to protect patients' identities and health information protected by State and federal law.

AI Summary

Committee Categories

Carol Murphy (D)*, 

Introduced, Referred to Assembly Health and Senior Services Committee (on 05/16/2019)

Official Document