Bill > A4953

This bill amends existing healthcare legislation to introduce several key protections for patients and providers in the pharmacy benefits management industry. The bill requires pharmacy benefits managers (PBMs) to establish a pharmacy and therapeutics committee with strict conflict of interest guidelines, and prohibits these committees from recommending prescription drugs based solely on cost. The legislation mandates that PBM compensation be structured as a flat fee rather than a commission, and requires PBMs to disclose any third-party broker fees. The bill also establishes a fiduciary duty for PBMs to act in the best interests of carriers and state health benefit programs, and introduces provisions to ensure fair reimbursement rates for pharmacies. Specifically, PBMs must reimburse pharmacies using the National Average Drug Acquisition Cost (NADAC) benchmark, cannot engage in differential payment pricing based on pharmacy ownership, and are prohibited from requiring patients to use pharmacies in which the PBM has an ownership interest. Additionally, the bill aims to prevent PBMs from manipulating drug formularies to favor higher-cost medications and ensures that independent pharmacies are not unfairly disadvantaged in the marketplace. These changes are designed to increase transparency, reduce potential conflicts of interest, and protect both patients and healthcare providers in the prescription drug ecosystem.

Budget and Finance, Business and Industry

https://www.njleg.state.nj.us/bill-search/2024/A4953