ASSEMBLY, No. 3873

 

STATE OF NEW JERSEY

 

210th LEGISLATURE

 

INTRODUCED DECEMBER 11, 2003

 

 

Sponsored by:

Assemblyman JOHN J. BURZICHELLI

District 3 (Salem, Cumberland and Gloucester)

Assemblyman DOUGLAS H. FISHER

District 3 (Salem, Cumberland and Gloucester)

Assemblyman GORDON M. JOHNSON

District 37 (Bergen)

 

Co-Sponsored by:

Assemblyman Diegnan

 

 

 

 

SYNOPSIS

    Establishes New Jersey Rx Program to reduce prescription drug prices.

 

CURRENT VERSION OF TEXT

    As introduced.

 

(Sponsorship Updated As Of: 12/12/2003)


An Act establishing the New Jersey Rx Program and supplementing Title 26 of the Revised Statutes.

 

    Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

    1. The Legislature finds and declares that affordability is critical in providing access to prescription drugs for New Jersey residents, and that the provisions of this act will enable the State to act as a pharmacy benefit manager in order to make prescription drugs more affordable for qualified State residents, and thereby increase the overall health and welfare of the citizens of this State; however, it is not the intent of the State to discourage employers from offering or paying for prescription drug benefits for their employees or to replace employer-sponsored prescription drug benefit plans that provide benefits comparable to those that are made available to qualified New Jersey residents pursuant to this act.

    The Legislature further finds and declares that the New Jersey Rx Program established pursuant to this act will ultimately benefit the State Medicaid program by providing State residents with the means for obtaining preventive drug therapies, thereby staving off serious and costly ailments and health conditions that can lead residents into poverty and dependance on public assistance programs.

 

    2. As used in this act:

    "Advisory council" means the "Rx Program Advisory Council" established pursuant to section 10 of this act.

    "Commissioner" means the Commissioner of Health and Senior Services.

    "Department" means the Department of Health and Senior Services.

    "Labeler" means an entity or person that receives prescription drugs from a manufacturer or wholesaler and repackages those drugs for later retail sale, and that has a labeler code from the federal Food and Drug Administration under 21 C.F.R. s.207.20.

    "Manufacturer" means a manufacturer of prescription drugs and includes a subsidiary or affiliate thereof.

    "Medicaid program" means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).

    "NJ FamilyCare" means the FamilyCare Health Coverage Program established pursuant to P.L.2000, c.71 (C.30:4J-1 et seq.) and the Children's Health Care Coverage Program established pursuant to P.L.1997, c.272 (C.30:4I-1 et seq.).

    "PAAD" means the pharmaceutical assistance to the aged and disabled program established pursuant to P.L.1975, c.194 (C.30:4D-20 et seq.).

    "Participant" means a person who has qualified for and received a New Jersey Rx Program enrollment card from the department.

    "Participating pharmacy" means a retail pharmacy located in this State, or another business licensed to dispense prescription drugs in this State, that participates in the New Jersey Rx Program and provides discounted prescription drug prices to qualified residents pursuant to this act.

    "Program" means the New Jersey Rx Program established pursuant to this act.

    "Qualified resident" means a resident of New Jersey who: has an annual income that does not exceed 300% of the federal poverty level; is not eligible for a State-funded program or covered by an insurance policy or contract that provides prescription drug benefits that are equal to or greater than the benefits provided under the program; and has qualified for and received a program enrollment card from the department.

    "Secondary discounted price" means a price that is equal to or less than the initial discounted price minus the amount of any rebate paid by the State to the participating pharmacy.

    "Senior Gold" means the "Senior Gold Prescription Discount Program" established pursuant to P.L.2001, c.96 (C.30:4D-43 et seq.).

 

    3. There is established the New Jersey Rx Program in the Department of Health and Senior Services in order to reduce prescription drug prices for qualified residents of this State in accordance with the provisions of this act.

 

    4. a. A manufacturer or labeler that sells prescription drugs in this State through any State-funded program that provides prescription drug benefits may enter into a rebate agreement with the department for this program. The rebate agreement shall require the manufacturer or labeler to make rebate payments to the State in each calendar quarter or according to a schedule established by the commissioner.

    b. In negotiating the amount of the rebate required pursuant to subsection a. of this section, the commissioner shall:

    (1) take into consideration the rebate calculated under the Medicaid program pursuant to 42 U.S.C. s.1396r-8, the average wholesale price of prescription drugs, and any other information on prescription drug prices and price discounts that the commissioner deems appropriate;

    (2) use the commissioner's best efforts to obtain an initial rebate amount equal to or greater than the rebate calculated under the Medicaid program; and

    (3) with respect to the rebate that shall take effect no later than October 1, 2005 under this act, use the commissioner's best efforts to obtain an amount equal to or greater than the amount of any discount, rebate or price reduction for prescription drugs provided to the federal government.

 

    5. A participating pharmacy that sells prescription drugs covered by a rebate agreement pursuant to section 4 of this act shall discount the retail price of those drugs sold to qualified residents.

    a. (1) The commissioner shall establish discounted prices for drugs covered by a rebate agreement and shall promote the use of efficacious and reduced-cost drugs, taking into consideration reduced prices for State and federally-funded programs that provide prescription drug benefits, differential dispensing fees, administrative overhead and incentive payments.

    (2) In the case of a combination of drugs that are prescribed in conjunction with each other to treat a specific disease, illness or other medical condition in accordance with a treatment regimen that the commissioner determines to be in the best interest of providing appropriate medical care for that disease, illness or medical condition, but which combination includes one or more drugs that are not covered by a rebate agreement, the commissioner shall establish discounted prices for those drugs that are not covered by a rebate agreement when prescribed in that combination for that disease, illness or medical condition.

    (3) In the case of a drug that is prescribed for a specific disease, illness or other medical condition, with respect to which the commissioner determines that there is no therapeutic equivalent for that disease, illness or medical condition, but which drug is not covered by a rebate agreement, the commissioner shall establish a discounted price for that drug when prescribed for that disease, illness or medical condition.

    b. Pursuant to subsection a. of this section, a participating pharmacy shall offer:

    (1) beginning January 1, 2005 an initial discounted price; and

    (2) no later than October 1, 2005 a secondary discounted price.

    c. In determining the amount of discounted prices, the commissioner shall consider, as applicable, an average of all rebates provided pursuant to section 4 of this act, weighted by sales of drugs subject to these rebates over the most recent 12-month period for which information is available.

 

    6. a. The Board of Pharmacy in the Division of Consumer Affairs in the Department of Law and Public Safety, in consultation with the commissioner, shall adopt rules requiring disclosure by participating pharmacies to qualified residents of the amount of savings provided as a result of the program. The rules shall consider and protect information that is proprietary in nature.

    b. The department shall not impose transaction charges under this program on retail pharmacies that submit claims or receive payments under the program.

    c. A participating pharmacy shall submit claims to the department to verify the amount charged to qualified residents pursuant to section 5 of this act.

    d. On a weekly or biweekly basis, the department shall reimburse a participating pharmacy for discounted prices provided to qualified residents pursuant to section 5 of this act and dispensing fees that shall be set by the commissioner.

    e. The department shall collect such utilization data from the participating pharmacies submitting claims as are necessary to calculate the amount of the rebate from the manufacturer or labeler. The department shall protect the confidentiality of all information subject to the provisions of State and federal law, rule or regulation.

 

    7. The names of manufacturers and labelers who do not enter into rebate agreements pursuant to section 4 of this act shall be considered public information, and the department shall release this information to health care providers and the public. In addition, the dispensing of prescription drugs provided by those manufacturers and labelers shall be subject to the provisions of section 11 of this act.

 

    8. a. If there is a discrepancy in the manufacturer's or labeler's favor between the amount claimed by the pharmacy and the amount rebated by the manufacturer or labeler, the department, at the department's expense, may hire a mutually agreed-upon independent auditor to verify the accuracy of the data supplied by the manufacturer or labeler. If a discrepancy still exists following the audit by the independent auditor, the manufacturer or labeler shall justify the reason for the discrepancy or make payment to the department for any additional amount due.

    b. If there is a discrepancy against the interest of the manufacturer or labeler in the information provided by the department to the manufacturer or labeler regarding the manufacturer's or labeler's rebate, the manufacturer or labeler, at the manufacturer's or labeler's expense, may hire a mutually agreed-upon independent auditor to verify the accuracy of the data supplied to the department. If a discrepancy still exists following the audit, the department shall justify the reason for the discrepancy or refund to the manufacturer any excess payment made by the manufacturer or labeler.

    c. Following the procedures established under subsections a. or b. of this section, either the department or the manufacturer or labeler, as applicable, may request a hearing before an administrative law judge, and shall accompany the request with supporting documentation for the hearing.


    9. a. There is created in the Department of the Treasury a special nonlapsing fund, to be known as the New Jersey Rx Dedicated Fund, which shall be a dedicated fund to serve as a depository for monies received from manufacturers and labelers who pay rebates pursuant to section 4 of this act and any appropriations or allocations designated for the fund. The monies in the fund shall be administered by the State Treasurer, and all interest on monies in the fund shall be credited to the fund.

    b. The monies in the fund shall be used exclusively to:

    (1) reimburse retail pharmacies for discounted prices provided to qualified residents pursuant to section 5 of this act;

    (2) reimburse the department for contracted services, administrative and associated computer costs, dispensing fees paid to participating retail pharmacies and other reasonable program costs; and

    (3) ensure that benefits and eligibility under other State-funded programs that provide prescription drug benefits are not reduced.

 

    10. There is established the "Rx Program Advisory Council" in the department to advise the commissioner on the implementation and operation of the program.

    a. The advisory council shall include the commissioner and the Commissioner of Human Services, or their designees, as ex officio members, and 15 public members as follows:

    (1) five physicians who represent a cross-section of professional specialties and four pharmacists, who shall be appointed by the Governor with the advice and consent of the Senate; and

    (2) six members of the public who are health care consumers, of whom two shall be appointed by the Governor with the advice and consent of the Senate, two shall be appointed by the President of the Senate, and two shall be appointed by the Speaker of the General Assembly.

    b. The advisory council shall organize as soon as possible after the appointment of its members, and shall annually select from its membership a chairman who shall serve until his successor shall be elected and shall qualify. The members shall also select a secretary who need not be a member of the advisory council.

    c. The public members shall serve for a term of three years; except that, of the public members first appointed by the Governor, six shall serve for a term of three years, five for a term of two years, and four for a term of one year.

    d. A vacancy in the membership of the advisory council other than by the expiration of a term shall be filled in the same manner as the original appointment, but for the unexpired term only.

    e. The members of the advisory council shall serve without compensation, but shall be reimbursed for the reasonable expenses incurred in the performance of their duties.

    f. The department shall provide such staff and administrative support to the advisory council as it requires to carry out its responsibilities.

 

    11. a. (1) The commissioner, in consultation with the advisory council, shall establish a preferred drug list for PAAD and Senior Gold. The commissioner shall exclude from the list those prescription drugs that are not covered by a rebate agreement pursuant to section 4 of this act, and shall impose prior authorization requirements under those programs for the dispensing of prescription drugs that are not included in the list, except as provided in paragraph (2) of this subsection.

    (2) The commissioner, in consultation with the advisory council, may exempt from the prior authorization requirement imposed pursuant to paragraph (1) of this subsection such prescription drugs, or prescription drugs for persons with such diagnoses, as the commissioner determines to be in the best interest of providing appropriate medical care to PAAD and Senior Gold recipients.

    b. (1) The Commissioner of Human Services, in consultation with the advisory council, shall establish a preferred drug list for the Medicaid program and NJ FamilyCare. The Commissioner of Human Services shall exclude from the list those prescription drugs that are not covered by a rebate agreement pursuant to section 4 of this act, and shall impose prior authorization requirements under those programs, as permitted by law, for the dispensing of prescription drugs that are not included in the preferred drug list, except as provided in paragraph (2) of this subsection.

    (2) The Commissioner of Human Services may, in consultation with the advisory council, exempt from the prior authorization requirement imposed pursuant to paragraph (1) of this subsection such prescription drugs, or prescription drugs for persons with such diagnoses, as the Commissioner of Human Services determines to be in the best interest of providing appropriate medical care to Medicaid and NJ FamilyCare recipients.

    c. Any prior authorization requirement imposed pursuant to subsection a. or b. of this section shall meet any applicable requirements set forth in federal law governing prior authorization for the dispensing of prescription drugs in the Medicaid program, and shall ensure that, with respect to a recipient of benefits under PAAD, Senior Gold, the Medicaid program or NJ FamilyCare:

    (1) the person who requests prior authorization by telephone or on-line for the dispensing of a prescription drug to the recipient shall receive a response to that request from a pharmacist on the staff of the department or the Department of Human Services, as applicable, within 24 hours of making the request;

    (2) notwithstanding the prior authorization requirement to the contrary, the recipient shall be entitled to receive a 72-hour supply of the prescribed drug, without obtaining the required prior authorization, in an emergency as determined by the prescriber;

    (3) the recipient or other person on the recipient's behalf shall be provided with an opportunity to appeal, to the commissioner or the Commissioner of Human Services, as applicable, a denial of authorization for the dispensing of that prescription drug, after receipt of the 72-hour emergency supply pursuant to paragraph (2) of this subsection; and

    (4) upon appeal, the commissioner or the Commissioner of Human Services, as applicable, shall authorize the dispensing of the prescription drug if he determines that there is no therapeutic equivalent available for the recipient's disease, illness or other medical condition.

 

    12. For the purposes of this act, the commissioner:

    a. shall establish simplified procedures for determining eligibility and issuing program enrollment cards to qualified residents;

    b. shall undertake outreach efforts to build public awareness of the program and maximize enrollment of qualified residents;

    c. may adjust the requirements and terms of the program to accommodate any new federally funded prescription drug programs;

    d. may contract with a third party administrator to administer any or all components of the program, including, but not limited to, outreach, eligibility, claims, administration and rebate recovery and redistribution;

    e. shall administer the program in a manner that is advantageous to the program and to its enrollees, and may seek to coordinate the program with other State-funded programs that provide prescription drug benefits;

    f. may seek to negotiate and to enter into a purchasing alliance or a regional strategy with one or more governments of other jurisdictions, and with other public and private entities, for the purpose of reducing prescription drug prices for residents of this State;

    g. may seek any waivers of federal law, rules or regulations necessary to implement the provisions of this act; and

    h. shall annually report the enrollment and financial status of the program to the Governor and the Legislature.

 

    13. a. The provisions of any law, or rule or regulation adopted pursuant thereto, to the contrary notwithstanding, the commissioner shall not award a contract to any person to administer any or all components of the program pursuant to subsection d. of section 12 of this act if the person has solicited or made any contribution of money, or pledge of contribution, including in-kind contributions, to any candidate for the office of Governor or for the office of member of the Legislature, or to any State, county or municipal party committee or legislative leadership committee, in excess of the thresholds specified in subsection b. of this section within one calendar year immediately preceding commencement of negotiations for the contract, or between the commencement of negotiations for and the later of the termination of negotiations or the completion of the contract.

    b. A person with whom the commissioner contracts to administer any or all components of the program pursuant to subsection d. of section 12 of this act may annually contribute a maximum of $250 for any purpose to any candidate for the office of Governor or for the office of member of the Legislature, or $500 to any State, county or municipal party committee or legislative leadership committee, without violating subsection a. of this section; however, the person in the aggregate shall not annually contribute for any purpose in excess of $5,000 to all candidates for the office of Governor or for the office of member of the Legislature, and all State, county and municipal political parties and legislative leadership committees combined, without violating subsection a. of this section.

    c. No contribution of money or other thing of value, including in-kind contributions, made by a person with whom the commissioner contracts to administer any or all components of the program pursuant to subsection d. of section 12 of this act, to any candidate for the office of Governor or for the office of member of the Legislature or State, county or municipal party committee or legislative leadership committee shall be deemed a violation of section a. of this section nor shall an agreement for property, goods or services, of any kind whatsoever, be disqualified thereby, if that contribution was made by the person prior to the effective date of this act.

    d. (1) Prior to awarding a contract to a person pursuant to subsection d. of section 12 of this act, the commissioner shall receive a sworn statement from the person made under penalty of perjury that the person has not made a contribution in violation of subsection a. of this section.

    (2) A person shall have a continuing duty to report any violations of this section that may occur during the negotiation of duration of the contract.

    e. Candidates for the office of Governor or for the office of member of the Legislature, and State and county party committees and legislative leadership committees, shall use reasonable efforts to notify contributors and potential contributors that contributions, including in-kind contributions, may affect the ability of the contributor to contract or continue to contract with the commissioner pursuant to subsection d. of section 12 of this act. Such reasonable efforts shall include, but need not be limited to, notification in written fundraising solicitations or donor information request forms or other fundraising solicitation materials. A person's failure to receive the notice prescribed in this subsection shall not be a defense to a violation of subsection a. of this section.

    f. A contributor, candidate for the office of Governor or for the office of member of the Legislature, an officeholder or a State, county or municipal party committee or legislative leadership committee may cure a violation of subsection a. of this section if, within 30 days after the election for which a contribution is made, the contributor seeks and receives reimbursement of a contribution from the candidate for the office of Governor or for the office of member of the Legislature or State, county or municipal political party or legislative leadership committee.

    g. It shall be a breach of the terms of a contract established pursuant to subsection d. of section 12 of this act for a person to make a contribution of money or other thing of value in violation of subsection a. of this section or to knowingly conceal or misrepresent contributions given or received, or to make or solicit contributions through intermediaries for the purpose of concealing or misrepresenting the source of the contribution, and any such person shall be subject to penalties prescribed in subsection i. of this section and any other penalties prescribed by law.

    h. No person shall make and no person, other than a candidate or an official representative of the candidate committee or joint candidates committee of the candidate, shall accept any contribution on the condition or with the agreement that it will be contributed to any other particular candidate, subject to penalties prescribed in subsection i. of this section and any other penalties prescribed by law. The expenditure of funds received by a person shall be made at the sole discretion of the recipient person.

    i. A person who knowingly fails to reveal a contribution made in violation of subsection a. of this section, or who knowingly makes or solicits contributions through intermediaries for the purpose of concealing or misrepresenting the source of the contribution, shall be disqualified from eligibility for a future contract with the commissioner pursuant to subsection d. of section 12 of this act for a period of four calendar years from the date of the determination of violation, and shall have any such contract in effect immediately terminated.

    j. (1) A person with whom the commissioner contracts to administer any or all components of the program pursuant to subsection d. of section 12 of this act, who makes a contribution to any candidate, committee, or political party, shall have filed an annual disclosure statement with the New Jersey Election Law Enforcement Commission setting forth any such contribution made during the 12 months prior to the reporting deadline.

    (2) The Election Law Enforcement Commission shall prescribe forms and procedures for the reporting required in paragraph (1) of this subsection, which, at a minimum, shall require the following information:

    (a) the name and address of the person making the contributions, and the amount contributed; and

    (b) the name of the candidate committee or political party receiving the contribution.

    (3) The Election Law Enforcement Commission shall maintain a list of such reports for public inspection both at the commission's office and through the electronic disclosure Web site of the commission.

    k. As used in this section, "contribution," "in-kind contribution," "other thing of value," "candidate," "candidate committee," "joint candidates committee," "legislative leadership committee," "State, county or municipal political party" and "State, county or municipal party committee" shall have the meanings set forth in "The New Jersey Campaign Contributions and Expenditures Reporting Act," P.L.1973, c.83 (C.19:44A-1 et seq.).

 

    14. A third party administrator with whom the commissioner contracts to administer any or all components of the program pursuant to subsection d. of section 12 of this act shall be required to adhere to the same ethical standards as those required for public employees under Executive Order No. 10 (2002).

 

    15. a. The commissioner, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) and in consultation with the Commissioner of Human Services and the advisory council, shall adopt rules and regulations to effectuate the purposes of this act, including rules and regulations with respect to PAAD and Senior Gold concerning requirements for prior authorization for the dispensing of prescription drugs to persons enrolled in these programs that are provided by manufacturers and labelers who do not enter into agreements with the department pursuant to this act, and whose prescription drugs are not included in the preferred drug list for these programs established pursuant to section 11 of this act.

    b. The Commissioner of Human Services, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) and in consultation with the commissioner and the advisory council, shall adopt rules and regulations with respect to the Medicaid program and NJ FamilyCare, concerning requirements for prior authorization for the dispensing of prescription drugs to persons enrolled in those programs that are provided by manufacturers and labelers who do not enter into agreements with the department pursuant to this act, and whose prescription drugs are not included in the preferred drug list for these programs established pursuant to section 11 of this act.

 

    16. This act shall take effect on July 1, 2004.

 

 

STATEMENT

 

    This bill establishes the New Jersey Rx Program to reduce prescription drug prices for residents of this State. This program, modeled after the program established by statute in Maine (P.L.1999, c.786), is to be established in the Department of Health and Senior Services (DHSS), and is designed for the State to utilize manufacturer rebates and pharmacy discounts to reduce prescription drug prices. In implementing the program, the State will act as a pharmacy benefits manager in establishing rebates and discounts on behalf of qualified residents whose income does not exceed 300% of the federal poverty level, and who are not eligible for a State-funded program or covered by an insurance policy or contract that provides prescription drug benefits that are equal to or greater than the benefits provided under the New Jersey Rx Program.

    Specifically, the bill provides as follows:

--A drug manufacturer or labeler that sells prescription drugs in this State through any State-funded program that provides prescription drug benefits may enter into a rebate agreement with DHSS for the New Jersey Rx Program, to be negotiated with the Commissioner of Health and Senior Services.

--A participating pharmacy that sells prescription drugs covered by a rebate agreement pursuant to this bill is required to discount the retail price of those drugs sold to qualified residents in accordance with a process established by the commissioner.

--On a weekly or biweekly basis, DHSS will reimburse a participating pharmacy for discounted prices provided to qualified residents pursuant to this bill and dispensing fees that are to be set by the commissioner.

--The names of manufacturers and labelers who do not enter into rebate agreements pursuant to this bill will be considered public information, and DHSS is to release this information to health care providers and the public.

--A special nonlapsing fund is established in the Department of the Treasury, to be known as the New Jersey Rx Dedicated Fund, which is to serve as a depository for monies received from manufacturers and labelers who pay rebates pursuant to this bill and any appropriations or allocations designated for the fund. The monies in the fund will be used exclusively to:

    -reimburse retail pharmacies for discounted prices provided to qualified residents pursuant to this bill;

    -reimburse DHSS for contracted services, administrative and associated computer costs, dispensing fees paid to participating retail pharmacies and other reasonable program costs; and

    -ensure that benefits and eligibility under other State-funded programs that provide prescription drug benefits are not reduced.

--The Rx Program Advisory Council is established in DHSS to advise the commissioner on the implementation and operation of the program. The advisory council is to include the Commissioner of Health and Senior Services and the Commissioner of Human Services, or their designees, as ex officio members, and 15 public members as follows:

    -five physicians who represent a cross-section of professional specialties and four pharmacists, to be appointed by the Governor; and

    -six members of the public who are health care consumers, of whom two are appointed by the Governor, two by the President of the Senate, and two by the Speaker of the General Assembly.

--The Commissioner of Health and Senior Services, in consultation with the advisory council, will establish a preferred drug list, which is to exclude those prescription drugs that are not covered by a rebate agreement pursuant to the bill, and impose prior authorization requirements for PAAD and Senior Gold for drugs that are not on the list; and the Commissioner of Human Services will do the same for Medicaid and NJ FamilyCare, as permitted by law.

--Each commissioner, in consultation with the advisory council, may, however, exempt from prior authorization requirements such prescription drugs, or prescription drugs for persons with such diagnoses, as the commissioner determines to be in the best interest of providing appropriate medical care to recipients of the applicable program.

--Any prior authorization requirement imposed pursuant to the bill must meet any applicable requirements set forth in federal law governing prior authorization for the dispensing of prescription drugs in the Medicaid program, and must ensure that, with respect to a recipient of benefits under PAAD, Senior Gold, the Medicaid program or NJ FamilyCare:

    -the person who requests prior authorization by telephone or on-line for the dispensing of a prescription drug to the recipient will receive a response to that request from a pharmacist on the staff of DHSS or the Department of Human Services, as applicable, within 24 hours of making the request;

    -notwithstanding the prior authorization requirement to the contrary, the recipient is entitled to receive a 72-hour supply of the prescribed drug, without obtaining the required prior authorization, in an emergency as determined by the prescriber;

    - the recipient or other person on the recipient's behalf must be provided with an opportunity to appeal, to the Commissioner of Health and Senior Services or the Commissioner of Human Services, as applicable, a denial of authorization for the dispensing of that prescription drug after receipt of the 72-hour emergency supply; and

    -upon appeal, the Commissioner of Health and Senior Services or the Commissioner of Human Services, as applicable, is to authorize the dispensing of the prescription drug if he determines that there is no therapeutic equivalent available for the recipient's disease, illness or other medical condition.

--For the purposes of this bill, the commissioner:

    -will establish simplified procedures for determining eligibility and issuing New Jersey Rx Program enrollment cards to qualified residents;

    -will undertake outreach efforts to build public awareness of the program and maximize enrollment of qualified residents;

    -may adjust the requirements and terms of the program to accommodate any new federally funded prescription drug programs;

    -may contract with a third party administrator to administer any or all components of the program, including, but not limited to, outreach, eligibility, claims, administration and rebate recovery and redistribution;

    -will administer the program in a manner that is advantageous to the program and to its enrollees, and may seek to coordinate the program with other State-funded programs that provide prescription drug benefits;

    -may seek to negotiate and to enter into a purchasing alliance or a regional strategy with one or more governments of other jurisdictions, and with other public and private entities, for the purpose of reducing prescription drug prices for residents of this State;

    -may seek any waivers of federal law, rules or regulations necessary to implement the provisions of this bill; and

    -will annually report the enrollment and financial status of the program to the Governor and the Legislature.

--The Commissioner of Health and Senior Services is prohibited from awarding a contract to any person to administer any or all components of the New Jersey Rx Program if the person has solicited or made any contribution of money, or pledge of contribution, including in-kind contributions, to any candidate for the office of Governor or for the office of member of the Legislature, or to any State, county or municipal party committee or legislative leadership committee, in excess of the thresholds specified in the bill within one calendar year immediately proceeding commencement of negotiations for the contract, or between the commencement of negotiations for and the later of the termination of negotiations or the completion of the contract.

--A third party administrator with whom the commissioner contracts to administer any or all components of the New Jersey Rx Program will be required to adhere to the the same ethical standards as those required for public employees under Executive Order No. 10 (2002).