Bill > S4806

This bill establishes new requirements for pharmacy benefit managers (PBMs), which are intermediary companies that manage prescription drug benefits for health insurance plans. The bill mandates that PBMs must pay or respond to pharmacy claims within 14 calendar days, either by reimbursing the claim or sending a written or electronic notice contesting or denying the claim. Additionally, the bill requires PBMs to update pricing information every seven calendar days and provide a process for pharmacies to access pricing lists. The legislation also strengthens data transparency by requiring carriers and health benefits plans to have access to all data related to prescription drug benefits, including personal information and transaction records, while ensuring compliance with federal health information privacy laws. Furthermore, the bill mandates that carriers and PBMs provide annual records to the Department of Banking and Insurance for inspection, and imposes confidentiality requirements and potential civil penalties for unauthorized disclosure of submitted information. The new requirements will take effect on the first day of the fourth month following the bill's enactment, with the Commissioner of Banking and Insurance able to take preparatory administrative actions in advance.

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https://www.njleg.state.nj.us/bill-search/2024/S4806