Bill Text: NJ S4203 | 2026-2027 | Regular Session | Introduced
Bill Title: Requires certain standards be established for contracts between pharmacy benefits managers and health benefits plans.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced) 2026-05-11 - Introduced in the Senate, Referred to Senate Commerce Committee [S4203 Detail]
Download: New_Jersey-2026-S4203-Introduced.html
Sponsored by:
Senator RAJ MUKHERJI
District 32 (Hudson)
SYNOPSIS
Requires certain standards be established for contracts between pharmacy benefits managers and health benefits plans.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning contract terms for pharmacy benefits managers and supplementing P.L.2015, c.179 (C.17B:27F-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A health benefits plan that provides coverage of prescription drugs or pharmacy services that is administered or managed by a pharmacy benefits manager shall allow any pharmacy that meets the standard contract terms and conditions under the benefits plan to participate as a network pharmacy.
b. The terms and conditions of the contract shall be reasonable and relevant as determined by the Commissioner of Banking and Insurance. To determine what is reasonable and relevant, the commissioner shall review, among other items:
(1) current terms and conditions in network pharmacy contracts; and
(2) reimbursement and dispensing fees paid by the health benefits plans and if the payments are sufficient to cover ingredient and operational costs.
2. The Commissioner of Banking and Insurance may adopt rules and regulations, in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), as are necessary to effectuate the provisions of this act.
3. This act shall take effect on the first day of the thirteenth month next following the date of enactment and shall apply to contracts between a health benefits plan and a pharmacy benefits manager that are initiated or renewed on or after the date of enactment.
STATEMENT
This bill requires a health benefits plan that provides coverage of prescription drugs or pharmacy services that is administered or managed by a pharmacy benefits manager to allow any pharmacy that meets the standard contract terms and conditions under the benefits plan to participate as a network pharmacy. The terms and conditions of the contract are to be reasonable and relevant as determined by the Commissioner of Banking and Insurance. To determine what is reasonable and relevant, the commissioner is to review, among other items: 1) current terms and conditions in network pharmacy contracts; and 2) reimbursement and dispensing fees paid by the health benefits plans and if the payments are sufficient to cover ingredient and operational costs.
