Sponsored by:
Senator M. TERESA RUIZ
District 29 (Essex)
SYNOPSIS
Prohibits pharmacy benefits managers from engaging in "clawback" and "gag clause" practices; requires certain price disclosures by pharmacists; requires Commissioner of Health to conduct public information campaign.
CURRENT VERSION OF TEXT
As introduced.
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 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 P.L.1960, c.39 (C.56:8-1 et seq.).
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, of the lowest cost option for the prescription drug.
3. a. The Commissioner of Health shall develop a public information campaign to educate consumers in this State about the lowest cost options for prescription drugs. As part of the information campaign, the commissioner shall develop a poster that informs consumers about their right to ask a pharmacist about the lowest cost option for any prescription drug.
b. A pharmacist at a pharmacy practice site shall display the poster required by subsection a. of this section in a highly visible location near the point of purchase for prescription drugs.
4. 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.
The bill also provides that a pharmacist at a pharmacy practice site shall inform each patient of the lowest cost option for the prescription drug, at the time of taking an order from the patient for home delivery or at the time of dispensing a prescription drug to the patient at the practice site.
Finally, the bill requires the Commissioner of Health to develop a public information campaign to educate consumers in this State about the lowest cost options for prescription drugs. As part of the information campaign, the commissioner shall develop a poster that informs consumers about their right to ask a pharmacist about the lowest cost option for any prescription drug. The bill further requires pharmacists to display the poster required in a highly visible location near the point of purchase for prescription drugs at the pharmacy practice site.