Sponsored by:
Assemblyman JOHN F. MCKEON
District 27 (Essex and Morris)
SYNOPSIS
Prohibits pharmacy benefits managers from collecting “clawback” copayments; requires certain language prohibiting “gag clauses” in contracts with pharmacists; provides certain penalties.
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.
c. Any provision of a contract that conflicts with the provisions of subsection b. of this section shall be void and unenforceable.
d. A violation of this section shall be an unlawful practice and a violation of the New Jersey consumer fraud act, P.L.1960, c.39 (C.56:8-1 et seq.).
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 addresses “gag clauses” by requiring 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 bill makes a provision of a contract that conflicts with the bill’s prohibitions on “gag clauses” void and unenforceable. The bill also provides that a violation of any provision of the bill is a violation of New Jersey’s consumer fraud act.