Bill Text: NJ S2690 | 2018-2019 | Regular Session | Chaptered
Bill Title: Prohibits pharmacy benefits managers and carriers from engaging in "clawback" and "gag clause" practices; requires certain disclosures by pharmacists; requires Director of Division of Consumer Affairs to conduct public information campaign.***
Spectrum: Moderate Partisan Bill (Democrat 17-5)
Status: (Passed) 2019-08-23 - Approved P.L.2019, c.257. [S2690 Detail]
Download: New_Jersey-2018-S2690-Chaptered.html
§1 - C.17B:27F-6
§§2,4 -
C.45:14-67.3 &
45:14-67.4
§3 - C.26:2S-10.9
§5 - Note
P.L. 2019, CHAPTER 257, approved August 23, 2019
Senate Committee Substitute (Second Reprint) for Senate, Nos. 2690 and 2727
An Act concerning pharmacy benefits managers and pharmacies and supplementing P.L.2015, c.179 (C.17B:27F-1 et seq.), P.L.2003, c.280 (C.45:14-40 et seq.), and Title 26 of the Revised Statutes.
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 2[charge] require2 a covered person 2to make a payment at the point of sale for any amount for a deductible, coinsurance payment, or2 a copayment for a prescription drug benefit in an amount that exceeds the 2[cost of the prescription drug that the pharmacy would charge to persons who do not purchase the prescription drug through their health insurance coverage] amount the covered person would pay for the prescription drug if the covered person purchased the prescription drug without using a health benefits plan2.
b. A pharmacy benefits manager shall not prohibit a network pharmacy from disclosing 2, and shall not apply a penalty or any other type of disincentive to a network pharmacy that discloses,2 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 P.L.1960, c.39 (C.56:8-1 et seq.) 2, and shall also be subject to any enforcement action that the Commissioner of Banking and Insurance is authorized to take pursuant to section 5 of P.L.2015, c.179 (C.17B:27F-5)2.
2. Notwithstanding any law or contract to the contrary, a pharmacist at a pharmacy practice site shall inform each patient, at the time of taking an order from a patient for home delivery or at the time of dispensing a prescription drug to the patient at the practice site:
a. of the lowest cost option for the prescription drug; and
b. whether there is an alternative drug that is less expensive and interchangeable with the prescription drug, and if needed, that the consumer can discuss with the prescribing health care provider whether the alternative drug would be appropriate for the consumer.
1[3. a. When a carrier provides coverage for a prescription drug under a covered person's health insurance policy or health benefits plan, and the covered person elects not to use that coverage to purchase the prescription drug but instead purchases the prescription drug at a lesser cost than the covered person's copayment for that prescription drug if the covered person purchased the prescription drug using that coverage, then the carrier shall apply the amount of the lesser cost actually paid toward any individual or family out-of-pocket limits for that covered person's policy for that policy period, provided the covered person provides the carrier with a sales receipt that documents the amount the covered person paid for the prescription drug.
b. A carrier shall provide an annual notice to covered persons regarding the right of covered persons to have the costs that they actually paid applied to out-of-pocket limits for the policy under the circumstances set forth in subsection a. of this section.]1
13. a. A carrier that provides benefits for prescription drugs shall not 2[charge] require2 a covered person 2to make a payment at the point of sale for any amount for a deductible, coinsurance payment, or2 a copayment for a prescription drug benefit in an amount that exceeds the 2[cost of the prescription drug that the pharmacy would charge to persons who do not purchase the prescription drug through their health insurance coverage] amount the covered person would pay for the prescription drug if the covered person purchased the prescription drug without using a health benefits plan2.
b. A carrier shall not prohibit a network pharmacy from disclosing 2, and shall not apply a penalty or any other type of disincentive to a network pharmacy that discloses,2 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 P.L.1960, c.39 (C.56:8-1 et seq.) 2, and shall also be subject to any enforcement action that the Commissioner of Banking and Insurance is authorized to take pursuant to section 5 of P.L.2015, c.179 (C.17B:27F-5)2 .1
4. The 2[Commissioner] Director2 of 2[Health] the Division of Consumer Affairs in the Department of Law and Public Safety2 shall develop a public information campaign to educate consumers in this State about their right to 1[:
(1)]1 ask a pharmacist about the lowest cost option for any prescription drug 1[; and
(2) have their costs actually paid applied to out-of-pocket limits for the policy under the circumstances set forth in subsection a. of section 3 of this act]1.
As part of the information campaign, the 2[commissioner] director2 shall develop a method that informs consumers about these rights, in a highly visible location near the point of purchase for prescription drugs. The 2[commissioner] director2 shall integrate the consumer notification with other consumer informational requirements for pharmacists.
5. This act shall take effect on the 90th day next following enactment.
Prohibits pharmacy benefits managers and carriers from engaging in "clawback" and "gag clause" practices; requires certain disclosures by pharmacists; requires Director of Division of Consumer Affairs to conduct public information campaign.
