Bill Text: NJ S2781 | 2010-2011 | Regular Session | Introduced
Bill Title: Establishes standards for commercial insurers and Medicaid program implementing electronic prescribing systems.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced - Dead) 2011-03-10 - Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee [S2781 Detail]
Download: New_Jersey-2010-S2781-Introduced.html
Sponsored by:
Senator ROBERT M. GORDON
District 38 (Bergen)
Senator DAWN MARIE ADDIEGO
District 8 (Burlington)
SYNOPSIS
Establishes standards for commercial insurers and Medicaid program implementing electronic prescribing systems.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning electronic prescribing systems, amending P.L.1993, c.378, and supplementing P.L.1968, c.413 (C.30:4D-1 et seq.).
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.] P.L.2003, c.280 (C.45:14-40 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, under the same terms and conditions currently applicable to all other preferred or contracting providers, if the contract provides for coverage by contracted or preferred providers for pharmaceutical services, provided the pharmacy or pharmacist is registered pursuant to [R.S.45:14-1 et seq.] P.L.2003, c.280 (C.45:14-40 et seq.), and accepts the terms and conditions 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;
(4) (a) Provides that no subscriber shall be required to obtain pharmacy services and prescription drugs from a mail service pharmacy;
(b) Provides for no differential in any copayment applicable to any prescription drug of the same strength, quantity and days' supply, whether obtained from a mail service pharmacy or a non-mail service pharmacy, provided that the non-mail service pharmacy agrees to the same terms, conditions, price and services applicable to the mail service pharmacy; and
(c) Provides that the limit on days' supply is the same whether the prescription drug is obtained from a mail service pharmacy or a non-mail service pharmacy, and that the limit shall not be less than 90 days;
(5) Sets forth the auditing procedures to be used by the hospital service corporation and includes a provision that any audit shall take place at a time mutually agreeable to the pharmacy or pharmacist and the auditor. No audit by a hospital service corporation shall include a review of any document relating to any person or prescription plan other than those reimbursable by the hospital service corporation;
(6) Provides that the hospital service corporation, or any agent or intermediary thereof, including a third party administrator, shall not restrict or prohibit, directly or indirectly, a pharmacy from charging the subscriber for services rendered by the pharmacy that are in addition to charges for the drug, for dispensing the drug or for prescription counseling. Services rendered by the pharmacy for which additional charges are imposed shall be subject to the approval of the Board of Pharmacy. A pharmacy shall disclose to the purchaser the charges for the additional services and the purchaser's out-of-pocket cost for those services prior to dispensing the drug. A pharmacy shall not impose any additional charges for patient counseling or for other services required by the Board of Pharmacy or State or federal law;
(7) The provisions of P.L.1999, c.395 shall apply to all contracts delivered. issued or renewed on or after the effective date of P.L.1999, c.395.
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.
d. In order to ensure patient safety and quality of care, any electronic prescribing program that a hospital service corporation establishes, implements, or conducts in the State shall, at a minimum, include:
(1) an automated prior authorization request capability and screen for such request;
(2) an automated "dispense as written" request capability and screen for such request;
(3) for a prescribed product within a therapeutic category, a display of the full list of preferred and non-preferred products in that category;
(4) a list of alternative drugs that are bioequivalent and consistent with the Approved Drug Products with Therapeutic Equivalence Evaluations, known as the Orange Book, issued by the federal Food and Drug Administration; and
(5) a first-fill and refill notification system for the prescriber and the patient.
To the extent necessary, each electronic prescribing program shall ensure appropriate coordination and collaboration with pharmacies in the State.
The provisions of this subsection shall apply to an electronic prescribing program that is in operation on the effective date of this act or is established after the effective date.
(cf: P.L.1999, c.395, s.1)
2. Section 2 of P.L.1978, 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.] P.L.2003, c.280 (C.45:14-40 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, under the same terms and conditions currently applicable to all other preferred or contracting providers, if the contract provides for coverage by contracted or preferred providers for pharmaceutical services, provided the pharmacy or pharmacist is registered pursuant to [R.S.45:14-1 et seq.] P.L.2003, c.280 (C.45:14-40 et seq.), and accepts the terms and conditions 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;
(4) (a) Provides that no subscriber shall be required to obtain pharmacy services and prescription drugs from a mail service pharmacy;
(b) Provides for no differential in any copayment applicable to any prescription drug of the same strength, quantity and days' supply, whether obtained from a mail service pharmacy or a non-mail service pharmacy, provided that the non-mail service pharmacy agrees to the same terms, conditions, price and services applicable to the mail service pharmacy; and
(c) Provides that the limit on days' supply is the same whether the prescription drug is obtained from a mail service pharmacy or a non-mail service pharmacy, and that the limit shall not be less than 90 days;
(5) Sets forth the auditing procedures to be used by the medical service corporation and includes a provision that any audit shall take place at a time mutually agreeable to the pharmacy or pharmacist and the auditor. No audit by a medical service corporation shall include a review of any document relating to any person or prescription plan other than those reimbursable by the medical service corporation;
(6) Provides that the medical service corporation, or any agent or intermediary thereof, including a third party administrator, shall not restrict or prohibit, directly or indirectly, a pharmacy from charging the subscriber for services rendered by the pharmacy that are in addition to charges for the drug, for dispensing the drug or for prescription counseling. Services rendered by the pharmacy for which additional charges are imposed shall be subject to the approval of the Board of Pharmacy. A pharmacy shall disclose to the purchaser the charges for the additional services and the purchaser's out-of-pocket cost for those services prior to dispensing the drug. A pharmacy shall not impose any additional charges for patient counseling or for other services required by the Board of Pharmacy or State or federal law;
(7) The provisions of P.L.1999, c.395 shall apply to all contracts delivered. issued or renewed on or after the effective date of P.L.1999, c.395.
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.
d. In order to ensure patient safety and quality of care, any electronic prescribing program that a medical service corporation establishes, implements, or conducts in the State shall, at a minimum, include:
(1) an automated prior authorization request capability and screen for such request;
(2) an automated "dispense as written" request capability and screen for such request;
(3) for a prescribed product within a therapeutic category, a display of the full list of preferred and non-preferred products in that category;
(4) a list of alternative drugs that are bioequivalent and consistent with the Approved Drug Products with Therapeutic Equivalence Evaluations, known as the Orange Book, issued by the federal Food and Drug Administration; and
(5) a first-fill and refill notification system for the prescriber and the patient.
To the extent necessary, each electronic prescribing program shall ensure appropriate coordination and collaboration with pharmacies in the State.
The provisions of this subsection shall apply to an electronic prescribing program that is in operation on the effective date of this act or is established after the effective date.
(cf: P.L.1999, c.395, 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.] P.L.2003, c.280 (C.45:14-40 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, under the same terms and conditions currently applicable to all other preferred or contracting providers, if the contract provides for coverage by contracted or preferred providers for pharmaceutical services, provided the pharmacy or pharmacist is registered pursuant to [R.S.45:14-1 et seq.] P.L.2003, c.280 (C.45:14-40 et seq., and accepts the terms and conditions 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;
(4) (a) Provides that no subscriber shall be required to obtain pharmacy services and prescription drugs from a mail service pharmacy;
(b) Provides for no differential in any copayment applicable to any prescription drug of the same strength, quantity and days' supply, whether obtained from a mail service pharmacy or a non-mail service pharmacy, provided that the non-mail service pharmacy agrees to the same terms, conditions, price and services applicable to the mail service pharmacy; and
(c) Provides that the limit on days' supply is the same whether the prescription drug is obtained from a mail service pharmacy or a non-mail service pharmacy, and that the limit shall not be less than 90 days;
(5) Sets forth the auditing procedures to be used by the health service corporation and includes a provision that any audit shall take place at a time mutually agreeable to the pharmacy or pharmacist and the auditor. No audit by a health service corporation shall include a review of any document relating to any person or prescription plan other than those reimbursable by the health service corporation;
(6) Provides that the health service corporation, or any agent or intermediary thereof, including a third party administrator, shall not restrict or prohibit, directly or indirectly, a pharmacy from charging the subscriber for services rendered by the pharmacy that are in addition to charges for the drug, for dispensing the drug or for prescription counseling. Services rendered by the pharmacy for which additional charges are imposed shall be subject to the approval of the Board of Pharmacy. A pharmacy shall disclose to the purchaser the charges for the additional services and the purchaser's out-of-pocket cost for those services prior to dispensing the drug. A pharmacy shall not impose any additional charges for patient counseling or for other services required by the Board of Pharmacy or State or federal law;
(7) The provisions of P.L.1999, c.395 shall apply to all contracts delivered. issued or renewed on or after the effective date of P.L.1999, c.395.
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.
d. In order to ensure patient safety and quality of care, any electronic prescribing program that a health service corporation establishes, implements, or conducts in the State shall, at a minimum, include:
(1) an automated prior authorization request capability and screen for such request;
(2) an automated "dispense as written" request capability and screen for such request;
(3) for a prescribed product within a therapeutic category, a display of the full list of preferred and non-preferred products in that category;
(4) a list of alternative drugs that are bioequivalent and consistent with the Approved Drug Products with Therapeutic Equivalence Evaluations, known as the Orange Book, issued by the federal Food and Drug Administration; and
(5) a first-fill and refill notification system for the prescriber and the patient.
To the extent necessary, each electronic prescribing program shall ensure appropriate coordination and collaboration with pharmacies in the State.
The provisions of this subsection shall apply to an electronic prescribing program that is in operation on the effective date of this act or is established after the effective date.
(cf: P.L.1999, c.395, 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.,] P.L.2003, c.280 (C.45:14-40 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, under the same terms and conditions currently applicable to all other preferred or contracting providers, if the policy provides for coverage by contracted or preferred providers for pharmaceutical services, provided the pharmacy or pharmacist is registered pursuant to [R.S.45:14-1 et seq.,] P.L.2003, c.280 (C.45:14-40 et seq.), and accepts the terms and conditions 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;
(4) (a) Provides that no insured shall be required to obtain pharmacy services and prescription drugs from a mail service pharmacy;
(b) Provides for no differential in any copayment applicable to any prescription drug of the same strength, quantity and days' supply, whether obtained from a mail service pharmacy or a non-mail service pharmacy, provided that the non-mail service pharmacy agrees to the same terms, conditions, price and services applicable to the mail service pharmacy; and
(c) Provides that the limit on days' supply is the same whether the prescription drug is obtained from a mail service pharmacy or a non-mail service pharmacy, and that the limit shall not be less than 90 days;
(5) Sets forth the auditing procedures to be used by the insurer and includes a provision that any audit shall take place at a time mutually agreeable to the pharmacy or pharmacist and the auditor. No audit by an insurer shall include a review of any document relating to any person or prescription plan other than those reimbursable by the insurer;
(6) Provides that the insurer, or any agent or intermediary thereof, including a third party administrator, shall not restrict or prohibit, directly or indirectly, a pharmacy from charging the insured for services rendered by the pharmacy that are in addition to charges for the drug, for dispensing the drug or for prescription counseling. Services rendered by the pharmacy for which additional charges are imposed shall be subject to the approval of the Board of Pharmacy. A pharmacy shall disclose to the purchaser the charges for the additional services and the purchaser's out-of-pocket cost for those services prior to dispensing the drug. A pharmacy shall not impose any additional charges for patient counseling or for other services required by the Board of Pharmacy or State or federal law;
(7) The provisions of P.L.1999, c.395 shall apply to all policies delivered. issued or renewed on or after the effective date of P.L.1999, c.395.
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.
d. In order to ensure patient safety and quality of care, any electronic prescribing program that an insurer establishes, implements, or conducts in the State shall, at a minimum, include:
(1) an automated prior authorization request capability and screen for such request;
(2) an automated "dispense as written" request capability and screen for such request;
(3) for a prescribed product within a therapeutic category, a display of the full list of preferred and non-preferred products in that category;
(4) a list of alternative drugs that are bioequivalent and consistent with the Approved Drug Products with Therapeutic Equivalence Evaluations, known as the Orange Book, issued by the federal Food and Drug Administration; and
(5) a first-fill and refill notification system for the prescriber and the patient.
To the extent necessary, each electronic prescribing program shall ensure appropriate coordination and collaboration with pharmacies in the State.
The provisions of this subsection shall apply to an electronic prescribing program that is in operation on the effective date of this act or is established after the effective date.
(cf: P.L.1999, c.395, 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.] P.L.2003, c.280 (C.45:14-40 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, under the same terms and conditions currently applicable to all other preferred or contracting providers, if the policy provides for coverage by contracted or preferred providers for pharmaceutical services, provided the pharmacy or pharmacist is registered pursuant to [R.S.45:14-1 et seq.] P.L.2003, c.280 (C.45:14-40 et seq.)., and accepts the terms and conditions 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;
(4) (a) Provides that no insured shall be required to obtain pharmacy services and prescription drugs from a mail service pharmacy;
(b) Provides for no differential in any copayment applicable to any prescription drug of the same strength, quantity and days' supply, whether obtained from a mail service pharmacy or a non-mail service pharmacy, provided that the non-mail service pharmacy agrees to the same terms, conditions, price and services applicable to the mail service pharmacy; and
(c) Provides that the limit on days' supply is the same whether the prescription drug is obtained from a mail service pharmacy or a non-mail service pharmacy, and that the limit shall not be less than 90 days;
(5) Sets forth the auditing procedures to be used by the insurer and includes a provision that any audit shall take place at a time mutually agreeable to the pharmacy or pharmacist and the auditor. No audit by an insurer shall include a review of any document relating to any person or prescription plan other than those reimbursable by the insurer;
(6) Provides that the insurer, or any agent or intermediary thereof, including a third party administrator, shall not restrict or prohibit, directly or indirectly, a pharmacy from charging the insured for services rendered by the pharmacy that are in addition to charges for the drug, for dispensing the drug or for prescription counseling. Services rendered by the pharmacy for which additional charges are imposed shall be subject to the approval of the Board of Pharmacy. A pharmacy shall disclose to the purchaser the charges for the additional services and the purchaser's out-of-pocket cost for those services prior to dispensing the drug. A pharmacy shall not impose any additional charges for patient counseling or for other services required by the Board of Pharmacy or State or federal law;
(7) The provisions of P.L.1999, c.395 shall apply to all policies delivered. issued or renewed on or after the effective date of P.L.1999, c.395.
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.
d. In order to ensure patient safety and quality of care, any electronic prescribing program that an insurer establishes, implements, or conducts in the State shall, at a minimum, include:
(1) an automated prior authorization request capability and screen for such request;
(2) an automated "dispense as written" request capability and screen for such request;
(3) for a prescribed product within a therapeutic category, a display of the full list of preferred and non-preferred products in that category;
(4) a list of alternative drugs that are bioequivalent and consistent with the Approved Drug Products with Therapeutic Equivalence Evaluations, known as the Orange Book, issued by the federal Food and Drug Administration; and
(5) a first-fill and refill notification system for the prescriber and the patient.
To the extent necessary, each electronic prescribing program shall ensure appropriate coordination and collaboration with pharmacies in the State.
The provisions of this subsection shall apply to an electronic prescribing program that is in operation on the effective date of this act or is established after the effective date.
(cf: P.L.1999, c.395, 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.] P.L.2003, c.280 (C.45:14-40 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, under the same terms and conditions currently applicable to all other preferred or contracting providers, if the health maintenance organization provides for coverage by contracted or preferred providers for pharmaceutical services, provided the pharmacy or pharmacist is registered pursuant to [R.S.45:14-1 et seq.] P.L.2003, c.280 (C.45:14-40 et seq.), and accepts the terms and conditions 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;
(4) (a) Provides that no enrollee shall be required to obtain pharmacy services and prescription drugs from a mail service pharmacy;
(b) Provides for no differential in any copayment applicable to any prescription drug of the same strength, quantity and days' supply, whether obtained from a mail service pharmacy or a non-mail service pharmacy, provided that the non-mail service pharmacy agrees to the same terms, conditions, price and services applicable to the mail service pharmacy; and
(c) Provides that the limit on days' supply is the same whether the prescription drug is obtained from a mail service pharmacy or a non-mail service pharmacy, and that the limit shall not be less than 90 days except for any health care-related programs funded in whole or in part with State funds, including, but not limited to, the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) and the "Children's Health Care Coverage Program" established pursuant to P.L.1997, c.272 (C.30:4I-1 et seq.);
(5) Sets forth the auditing procedures to be used by the health maintenance organization and includes a provision that any audit shall take place at a time mutually agreeable to the pharmacy or pharmacist and the auditor, unless authorized by the Division of Medical Assistance and Health Services in the Department of Human Services with regard to any health care-related programs funded in whole or in part with State funds, including, but not limited to, the Medicaid program and "Children's Health Care Coverage Program". No audit by a health maintenance organization shall include a review of any document relating to any person or prescription plan other than those reimbursable by the health maintenance organization, unless authorized by the Division of Medical Assistance and Health Services in the Department of Human Services with regard to any health care-related programs funded in whole or in part with State funds, including, but not limited to, the Medicaid program and "Children's Health Care Coverage Program";
(6) Provides that the health maintenance organization, or any agent or intermediary thereof, including a third party administrator, shall not restrict or prohibit, directly or indirectly, a pharmacy from charging the enrollee for services rendered by the pharmacy that are in addition to charges for the drug, for dispensing the drug or for prescription counseling. Services rendered by the pharmacy for which additional charges are imposed shall be subject to the approval of the Board of Pharmacy. A pharmacy shall disclose to the purchaser the charges for the additional services and the purchaser's out-of-pocket cost for those services prior to dispensing the drug. A pharmacy shall not impose any additional charges for patient counseling or for other services required by the Board of Pharmacy or the Division of Medical Assistance and Health Services in the Department of Human Services or State or federal law;
(7) The provisions of P.L.1999, c.395 shall apply to all health maintenance organization contracts delivered. issued or renewed on or after the effective date of P.L.1999, c.395.
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.
d. In order to ensure patient safety and quality of care, any electronic prescribing program that a health maintenance organization establishes, implements, or conducts in the State shall, at a minimum, include:
(1) an automated prior authorization request capability and screen for such request;
(2) an automated "dispense as written" request capability and screen for such request;
(3) for a prescribed product within a therapeutic category, a display of the full list of preferred and non-preferred products in that category;
(4) a list of alternative drugs that are bioequivalent and consistent with the Approved Drug Products with Therapeutic Equivalence Evaluations, known as the Orange Book, issued by the federal Food and Drug Administration; and
(5) a first-fill and refill notification system for the prescriber and the patient.
To the extent necessary, each electronic prescribing program shall ensure appropriate coordination and collaboration with pharmacies in the State.
The provisions of this subsection shall apply to an electronic prescribing program that is in operation on the effective date of this act or is established after the effective date.
(cf: P.L.1999, c.395, s.6)
7. (New section) a. In order to ensure patient safety and quality of care, any electronic prescribing program that the Medicaid program or NJ FamilyCare Program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) and P.L.2005, c.156 (C.30:4J-8 et al.), respectively, establishes, implements, or conducts in the State shall, at a minimum, include:
(1) an automated prior authorization request capability and screen for such request;
(2) an automated "dispense as written" request capability and screen for such request;
(3) for a prescribed product within a therapeutic category, a display of the full list of preferred and non-preferred products in that category;
(4) a list of alternative drugs that are bioequivalent and consistent with the Approved Drug Products with Therapeutic Equivalence Evaluations, known as the Orange Book, issued by the federal Food and Drug Administration; and
(5) a first-fill and refill notification system for the prescriber and the patient.
b. To the extent necessary, each electronic prescribing program shall ensure appropriate coordination and collaboration with pharmacies in the State.
c. The provisions of this section shall apply to an electronic prescribing program that is in operation on the effective date of this act or is established after the effective date.
8. This act shall take effect on the first day of the seventh month next following the date of enactment.
STATEMENT
In order to ensure patient safety and quality of care, this bill provides standards for electronic prescribing programs that are established, implemented, or conducted in the State by a hospital, medical or health service corporation, a commercial insurer under an individual or group health insurance policy, a health maintenance organization, and the Medicaid program and NJ FamilyCare Program.
Specifically, the bill provides that the electronic prescribing programs must, at a minimum, include:
· an automated prior authorization request capability and screen for such request;
· an automated "dispense as written" request capability and screen for such request;
· for a prescribed product within a therapeutic category, a display of the full list of preferred and non-preferred products in that category;
· a list of alternative drugs that are bioequivalent and consistent with the Approved Drug Products with Therapeutic Equivalence Evaluations, known as the Orange Book, issued by the federal Food and Drug Administration; and
· a first-fill and refill notification system for the prescriber and the patient.
In addition, the bill provides that, to the extent necessary, each electronic prescribing program must ensure appropriate coordination and collaboration with pharmacies in the State. The bill also specifies that it applies to an electronic prescribing program that is in operation on the effective date of the bill or is established after the effective date.
