Bill > A5217

This bill requires third-party discounts and payments for individuals covered by health benefits plans to apply to copayments, coinsurance, deductibles, or other out-of-pocket costs for covered benefits. Specifically, the bill establishes new regulations for carriers (insurance companies and health providers) and pharmacy benefits managers in New Jersey. The bill defines key terms like "cost-sharing amount" as any copayment, coinsurance, deductible, or similar charges for health care services, and requires carriers and pharmacy benefits managers to give credit for any cost-sharing amount paid by or on behalf of an enrollee. The legislation prohibits carriers and pharmacy benefits managers from altering health plan coverage terms based on the availability of financial assistance for prescription drugs. Each carrier and pharmacy benefits manager must annually certify to the Commissioner of Banking and Insurance that they have complied with these requirements. The bill also updates definitions and provisions related to health benefits plans and pharmacy benefits management services. The changes will apply to health plans delivered, issued, executed, or renewed 90 days after the bill's enactment, with the goal of making health care costs more transparent and potentially more affordable for consumers by ensuring that third-party discounts and payments are fully applied to an individual's out-of-pocket expenses.