Sponsored by:
Assemblywoman ANNETTE QUIJANO
District 20 (Union)
Assemblywoman VALERIE VAINIERI HUTTLE
District 37 (Bergen)
SYNOPSIS
“Prescription Drug Consumer Transparency Act.”
CURRENT VERSION OF TEXT
As introduced.
An Act concerning 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. This act shall be known as the “Prescription Drug Consumer Transparency Act.”
2. A pharmacy benefits manager shall disclose in the contract between the pharmacy benefits manager and the purchaser each of the following:
a. The basis of the methodology and sources utilized to establish multiple source generic pricing. Applicable lists shall be updated and provided to the purchaser whenever there is a change;
b. If a pharmacy benefits manager utilizes a multiple source generic list for drugs dispensed at retail, but does not utilize a similar list for drugs dispensed by mail. This practice shall be disclosed to the purchaser in writing either in the contract or no later than 21 business days from the implementation of the practice; and
c. Whether or not the pharmacy benefits manager is using the identical multiple source generic drug list with respect to billing the purchaser as it does when reimbursing all network pharmacies. If multiple source generic drug lists are used, the pharmacy benefits manager shall disclose any difference between the amount paid to any pharmacy and the amount charged to the purchaser.
3. A pharmacy benefits manager shall provide a toll-free telephone number through which a contracted pharmacy or a consumer may contact the pharmacy benefits manager and speak with a New Jersey-licensed pharmacist to resolve issues pertaining to benefits coverage, drug pricing and prescription drug safety. Callers shall not be placed on hold for longer than five minutes. The pharmacy benefits manager shall resolve concerns within 24 hours of receiving the inquiry.
4. This act shall take effect on the 90th day next following enactment and shall apply to all contracts or agreements for pharmacy benefits management services that are executed or renewed on or after the effective date.
STATEMENT
This bill supplements P.L.2015, c.179 (C.17B:27F-1 et seq.) by requiring pharmacy benefits managers (PBMs) to disclose certain information about prescription drug pricing and generic substitutions to benefit plan purchasers. The bill also requires PBMs to establish a toll-free telephone number through which consumers and pharmacists can quickly obtain information regarding coverage, pricing and prescription drug safety.
With respect to purchasers of pharmacy benefits management services, this bill requires PBMs to disclose, in the contract entered into between the purchaser and the PBM, the methodology and sources utilized to determine multiple source generic drug pricing. That pricing information shall be updated whenever a change occurs and must be provided to the purchaser. If a PBM uses a multiple source generic list for drugs dispensed at retail, but not for drugs dispensed by mail, this must be disclosed in the contract as well, or within 21 business days from the implementation of the practice. In addition, the bill requires PBMs to disclose to purchasers whether the multiple source generic pricing list used to bill the purchaser is the same as the list used to reimburse pharmacies. If the lists are not the same, the difference between the amount paid to the pharmacy and the amount charged to the purchaser shall be disclosed.
This bill also requires PBMs to provide a toll-free telephone number for consumers and contracted pharmacies to speak with a New Jersey-licensed pharmacist concerning benefits coverage, drug pricing and prescription drug safety. Callers may not be placed on hold for longer than five minutes, and concerns must be resolved within 24 hours.