ASSEMBLY, No. 1757

 

STATE OF NEW JERSEY

 

INTRODUCED MARCH 25, 1996

 

 

By Assemblyman ROBERTS and

Assemblywoman CRUZ-PEREZ

 

 

An Act concerning certain prescription drug plans and amending P.L.1993, c.378.

 

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

 

    1. Section 1 of P.L. 1993, c.378 (C.17:48-6j) is amended to read as follows:

    1. a. Notwithstanding any other provision of law to the contrary, no group or individual hospital service corporation contract which provides benefits for pharmacy services, prescription drugs, or for participation in a prescription drug plan, shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State on or after the effective date of this act, unless the contract:

    (1) Permits the subscriber, at the time of issuance, amendment or renewal, to select benefit coverage allowing the subscriber to choose a pharmacy or pharmacist for the provision of prescription drugs or pharmacy services, provided that any pharmacist or pharmacy selected by the subscriber is registered pursuant to R.S.45:14-1 et seq.;

    (2) Provides that no pharmacy or pharmacist shall be denied the right to participate as a preferred provider or as a contracting provider, if the contract provides for coverage by contracted or preferred providers, provided the pharmacy or pharmacist is registered pursuant to R.S.45:14-1 et seq., and accepts the terms of the contract;     (3) Provides that no copayment, fee, or other condition shall be imposed upon a subscriber selecting a participating or contracting pharmacist or pharmacy that is not also equally imposed upon all subscribers selecting a participating or contracting pharmacist or pharmacy; and

    (4) Provides: (a) that no subscriber shall be required to obtain pharmacy services and prescription drugs from a mail order pharmacy; and (b) for an identical copayment for the same quantity or supply of medication whether a mail order or a non-mail order pharmacy is used by a subscriber.

    b. Nothing in this section shall be construed to operate to add any benefit, to increase the scope of any benefit, or to increase any benefit level under any contract.

    c. This section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the subscriber charge.

(cf: P.L.1993, c.378, s.1)

 

    2. Section 2 of P.L.1993, c.378 (C.17:48A-7i) is amended to read as follows:

    2. a. Notwithstanding any other provision of law to the contrary, no group or individual medical service corporation contract which provides benefits for pharmacy services, prescription drugs, or for participation in a prescription drug plan, shall be delivered, issued, executed or renewed in this State or approved for issuance in this State on or after the effective date of this act, unless the contract:

    (1) Permits the subscriber, at the time of issuance, amendment or renewal, to select benefit coverage allowing the subscriber to choose a pharmacy or pharmacist for the provision of prescription drugs or pharmacy services, provided that any pharmacist or pharmacy selected by the subscriber is registered pursuant to R.S.45:14-1 et seq.;

    (2) Provides that no pharmacy or pharmacist shall be denied the right to participate as a preferred provider or as a contracting provider, if the contract provides for coverage by contracted or preferred providers, provided the pharmacy or pharmacist is registered pursuant to R.S.45:14-1 et seq., and accepts the terms of the contract;     (3) Provides that no copayment, fee, or other condition shall be imposed upon a subscriber selecting a participating or contracting pharmacist or pharmacy of his own choice, that is not also equally imposed upon all subscribers selecting a participating or contracting pharmacist or pharmacy; and

    (4) Provides: (a) that no subscriber shall be required to obtain pharmacy services and prescription drugs from a mail order pharmacy; and (b) for an identical copayment for the same quantity or supply of medication whether a mail order or non-mail order pharmacy is used by a subscriber.

    b. Nothing in this section shall be construed to operate to add any benefit, to increase the scope of any benefit, or to increase any benefit level under any contract.

    c. This section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the


right to change the subscriber charge.

(cf: P.L.1993, c.378, s.2)

 

    3. Section 3 of P.L.1993, c.378 (C.17:48E-35.7) is amended to read as follows:

    3. a. Notwithstanding any other provisions of law to the contrary, no group or individual health service corporation contract which provides benefits for pharmacy services, prescription drugs, or for participation in a prescription drug plan, shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State on or after the effective date of this act, unless the contract:

    (1) Permits the subscriber, at the time of issuance, amendment or renewal, to select benefit coverage allowing the subscriber to choose a pharmacy or pharmacist for the provision of prescription drugs or pharmacy services, provided that any pharmacist or pharmacy selected by the subscriber is registered pursuant to R.S.45:14-1 et seq.;

    (2) Provides that no pharmacy or pharmacist shall be denied the right to participate as a preferred provider or as a contracting provider, if the contract provides for coverage by contracted or preferred providers, provided the pharmacy or pharmacist is registered pursuant to R.S.45:14-1 et seq., and accepts the terms of the contract;     (3) Provides that no copayment, fee, or other condition shall be imposed upon a subscriber selecting a participating or contracting pharmacist or pharmacy that is not also equally imposed upon all subscribers selecting a participating or contracting pharmacist or pharmacy; and

    (4) Provides: (a) that no subscriber shall be required to obtain pharmacy services and prescription drugs from a mail order pharmacy; and (b) for an identical copayment for the same quantity or supply of medication whether a mail order or non-mail order pharmacy is used by a subscriber.

    b. Nothing in this section shall be construed to operate to add any benefit, to increase the scope of any benefit, or to increase any benefit level under any contract.

    c. This section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the subscriber charge.

(cf: P.L.1993, c.378, s.3)

 

    4. Section 4 of P.L.1993, c.378 (C.17B:26-2.1i) is amended to read as follows:

    4. a. Notwithstanding any other provision of law to the contrary, no individual health insurance policy which provides benefits for pharmacy services, prescription drugs, or for participation in a prescription drug plan, shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State on or after the effective date of this act, unless the policy:

    (1) Permits the insured, at the time of issuance, amendment or renewal, to select benefit coverage allowing the insured to choose a pharmacy or pharmacist for the provision of prescription drugs or pharmacy services, provided that any pharmacist or pharmacy selected by the insured is registered pursuant to R.S.45:14-1 et seq.;

    (2) Provides that no pharmacy or pharmacist shall be denied the right to participate as a preferred provider or as a contracting provider, if the policy provides for coverage by contracted or preferred providers, provided the pharmacy or pharmacist is registered pursuant to R.S.45:14-1 et seq., and accepts the terms of the policy;     (3) Provides that no copayment, fee, or other condition shall be imposed upon an insured selecting a participating or contracting pharmacist or pharmacy that is not also equally imposed upon all insureds selecting a participating or contracting pharmacist or pharmacy; and

    (4) Provides: (a) that no insured shall be required to obtain pharmacy services and prescription drugs from a mail order pharmacy; and (b) for an identical copayment for the same quantity or supply of medication whether a mail order or non-mail order pharmacy is used by a subscriber.

    b. Nothing in this section shall be construed to operate to add any benefit, to increase the scope of any benefit, or to increase any benefit level under any policy.

    c. This section shall apply to all individual health insurance policies in which the insurer has reserved the right to change the premium.

(cf: P.L.1993, c.378, s.4)

 

    5. Section 5 of P.L.1993, c.378 (C.17B:27-46.1i) is amended to read as follows:

    5. a. Notwithstanding any other provision of law to the contrary, no group health insurance policy which provides benefits for pharmacy services, prescription drugs, or for participation in a prescription drug plan, shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State, on or after the effective date of this act, unless the policy:

    (1) Permits the insured, at the time of issuance, amendment or renewal, to select benefit coverage allowing the insured to choose a pharmacy or pharmacist for the provision of prescription drugs or pharmacy services, provided that any pharmacist or pharmacy selected by the insured is registered pursuant to R.S.45:14-1 et seq.;

    (2) Provides that no pharmacy or pharmacist shall be denied the right to participate as a preferred provider or as a contracting provider, if the policy provides for coverage by contracted or preferred providers, provided the pharmacy or pharmacist is registered pursuant to R.S.45:14-1 et seq., and accepts the terms of the policy;     (3) Provides that no copayment, fee, or other condition shall be imposed upon an insured selecting a participating or contracting pharmacist or pharmacy that is not also equally imposed upon all insureds selecting a participating or contracting pharmacist or pharmacy; and

    (4) Provides: (a) that no insured shall be required to obtain pharmacy services and prescription drugs from a mail order pharmacy; and (b) for an identical copayment for the same quantity or supply of medication whether a mail order or non-mail order pharmacy is used by a subscriber.

    b. Nothing in this section shall be construed to operate to add any benefit, to increase the scope of any benefit, or to increase any benefit level under any policy.

    c. This section shall apply to all group health insurance policies in which the insurer has reserved the right to change the premium.

(cf: P.L.1993, c.378, s.5)

 

    6. Section 6 of P.L.1993, c.378 (C.26:2J-4.7) is amended to read as follows:

    6. a. Notwithstanding any provision of law to the contrary, a certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued on or after the effective date of this act for a health maintenance organization which provides pharmacy services, prescription drugs, or a prescription drug plan, unless the coverage for health care services:

    (1) Permits the enrollee, at the time of enrollment, to select benefit coverage allowing the enrollee to choose a pharmacy or pharmacist for the provision of prescription drugs or pharmacy services, provided that any pharmacist or pharmacy selected by the enrollee is registered pursuant to R.S.45:14-1 et seq.;

    (2) Provides that no pharmacy or pharmacist shall be denied the right to participate as a preferred provider or as a contracting provider, if the health maintenance organization provides for coverage by contracted or preferred providers, provided the pharmacy or pharmacist is registered pursuant to R.S.45:14-1 et seq., and accepts the terms of the health maintenance organization;

    (3) Provides that no copayment, fee, or other condition shall be imposed upon an enrollee selecting a participating or contracting pharmacist or pharmacy that is not also equally imposed upon all enrollees selecting a participating or contracting pharmacist or pharmacy; and

    (4) Provides: (a) that no enrollee shall be required to obtain pharmacy services and prescription drugs from a mail order pharmacy; and (b) for an identical copayment for the same quantity or supply of medication whether a mail order or non-mail order pharmacy is used by a subscriber.

    b. Nothing in this section shall be construed to operate to add any coverage for health care services, to increase the scope of any coverage for health care services, or to increase the level of any health care services provided by a health maintenance organization.

    c. This section shall apply to health maintenance organization plans in which the right to change the enrollee charge has been reserved.

(cf: P.L.1993, c.378, s.6)

 

    7. This act shall take effect immediately.

 

 

STATEMENT

 

    This bill provides that health insurers (hospital service corporations, medical service corporations, health service corporations, commercial insurers and health maintenance organizations) which provide prescription drug plans cannot have lower copayments for prescription drugs purchased through the mail. The bill requires an identical copayment for the same quantity or supply of medication whether a mail order or non-mail order pharmacy is used by a subscriber.

 

 

                             

Prohibits reduced copayments by prescription drug plans for use of mail order prescriptions.