Sponsored by:
Assemblyman RONALD S. DANCER
District 12 (Burlington, Middlesex, Monmouth and Ocean)
Assemblyman BOB ANDRZEJCZAK
District 1 (Atlantic, Cape May and Cumberland)
Assemblyman R. BRUCE LAND
District 1 (Atlantic, Cape May and Cumberland)
Co-Sponsored by:
Assemblyman A.M.Bucco and Assemblywoman Murphy
SYNOPSIS
Prohibits pharmacy benefits managers from collecting copayments in excess of certain amounts - “clawbacks”; requires certain language prohibiting “gag clauses” in contracts with pharmacists.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning pharmacy benefits managers and supplementing P.L.2015, c.179 (C.17B:27F-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A pharmacy benefits manager, in connection with any contract or arrangement with a private health insurer, prescription benefit plan, or the State Health Benefits Program or School Employees’ Health Benefits Program, shall not charge a covered person a copayment for a prescription drug benefit in an amount that exceeds the cost of the prescription drug that the pharmacy would charge to persons who do not purchase the prescription drug through their health insurance coverage.
b. A pharmacy benefits manager shall include in any contract between the pharmacy benefits manager and a pharmacy, language that permits the pharmacy to disclose to a covered person lower cost prescription drug options, including those that are available to the covered person if the covered person purchases the prescription drug without using health insurance coverage.
2. This act shall take effect on the 90th day next following enactment.
STATEMENT
This bill addresses “clawback schemes” by prohibiting a pharmacy benefits manager, in connection with any contract or arrangement with a private health insurer, prescription benefit plan, or the State Health Benefits Program or School Employees’ Health Benefits Program, from charging a covered person a copayment for a prescription drug benefit in an amount that exceeds the cost of the prescription drug that the pharmacy would charge to persons who do not purchase the drug through their health insurance coverage. The bill also requires a pharmacy benefits manager to include in any contract between the pharmacy benefits manager and a pharmacy, language that permits the pharmacy to disclose to a covered person lower cost prescription drug options, including those that are available to the covered person if the covered person purchases the prescription drug without using health insurance coverage.
The sponsor became aware of “clawback schemes,” as well as “gag clauses” that prevent pharmacists from telling their consumers about lower price options, from a national media news (NBC News) article. The sponsor considers this bill to be an important consumer protection measure, especially in light of the switch by the State Health Benefits Program to OptumRx as its pharmacy benefits manager as of January 1, 2018, and that OptumRx is currently the subject of two class action lawsuits.
According to the NBC News article, as of September, 2017, a total of 11 states have enacted laws to prohibit clawback practices or the use of gag clauses by pharmacy benefits managers.