Bill Text: NJ A3993 | 2018-2019 | Regular Session | Amended
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: Slight Partisan Bill (Democrat 9-5)
Status: (Introduced - Dead) 2019-06-20 - Substituted by S2690/2727 (SCS/2R) [A3993 Detail]
Download: New_Jersey-2018-A3993-Amended.html
[Third Reprint]
ASSEMBLY COMMITTEE SUBSTITUTE FOR
ASSEMBLY, Nos. 3993 and 2214
STATE OF NEW JERSEY
218th LEGISLATURE
ADOPTED JUNE 11, 2018
Sponsored by:
Assemblyman JOHN F. MCKEON
District 27 (Essex and Morris)
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, Assemblywoman Murphy, Assemblyman Benson, Assemblywomen Pinkin, B.DeCroce, Assemblymen Auth, Webber, Conaway and Assemblywoman Downey
SYNOPSIS
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.
CURRENT VERSION OF TEXT
As amended by the General Assembly on May 23, 2019.
An Act concerning pharmacy benefits managers 1and pharmacies1 and supplementing P.L.2015, c.179 (C.17B:27F-1 et seq.)1, P.L.2003, c.280 (C.45:14-40 et seq.), and Title 26 of the Revised Statutes1.
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 1network1 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 1[any provision] the provisions of subsection b.1 of this section shall be void and unenforceable.
d. A violation of 1[any provision of]1 this section shall be an unlawful practice and a violation of 1[the New Jersey consumer fraud act,]1 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.
12. 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
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
14. The 3[Commissioner] Director3 of 3[Health] the Division of Consumer Affairs in the Department of Law and Public Safety3 shall develop a public information campaign to educate consumers in this State about their right to ask a pharmacist about the lowest cost option for any prescription drug.
As part of the information campaign, the 3[commissioner] director3 shall develop a method that informs consumers about these rights, in a highly visible location near the point of purchase for prescription drugs. The 3[commissioner] director3 shall integrate the consumer notification with other consumer informational requirements for pharmacists.1
1[2.] 5.1 This act shall take effect on the 90th day next following enactment.
