New Jersey A 4005: Concerns certain Medicaid and health insurance audits and health care provider claims payment and denial during coronavirus disease 2019 pandemic.

Bill Text

A4005 

ASSEMBLY, No. 4005 

STATE OF NEW JERSEY

222nd LEGISLATURE

� 

INTRODUCED FEBRUARY 5, 2026

Sponsored by:

Assemblywoman� HEATHER SIMMONS

District 3 (Cumberland, Gloucester and Salem)

SYNOPSIS

���� Provides for procurement by State of pharmacy 
benefits manager, automated reverse auction services, and claims adjudication 
services. 

CURRENT VERSION OF TEXT 

���� As introduced.

�� 

An Act providing for the procurement by the State of a 
pharmacy benefits manager, automated reverse auction services, and claims 
adjudication services.

���� Be It 
Enacted by the Senate and General Assembly of 
the State of New Jersey:

���� 1.� a.� Notwithstanding the 
provisions of any other law, rule, or regulation to the contrary, a contract 
for the services of a pharmacy benefits manager for the State Health Benefits 
Program and the School Employees� Health Benefits Program shall be procured in 
an expedited process and in the manner provided by this section.

���� b.� The Division of Purchase 
and Property in the Department of the Treasury shall procure, without the need 
for formal advertisement, but through the solicitation of proposals from 
professional services vendors, from qualified vendors the following three 
services based upon price and other factors:

���� (1)�� technical assistance to 
the State to evaluate the qualifications of bidders on a pharmacy benefits 
manager procurement and to provide online automated reverse auction services to 
support the Department of the Treasury in comparing the pricing for the pharmacy 
benefits manager procurement.� The technology platform shall, if possible, 
utilize a re-pricing of pharmacy benefits manager proposals for the State 
Health Benefits Program and the School Employees� Health Benefits Program 
pharmacy spending utilizing code-based classification of drugs from 
nationally-accepted data sources of comparisons of the costs of pharmacy 
benefits manager proposals; 

���� (2)�� real-time, electronic, 
line-by-line, claim-by-claim review of invoiced pharmacy benefits manager 
pharmacy claims using an automated claims adjudication technology platform that 
allows for online comparison of pharmacy benefits manager invoices and auditing 
of other aspects of the services provided by the pharmacy benefits manager; and

���� (3)�� a pharmacy benefits 
manager and related services. 

���� c.� Notwithstanding the 
provisions of any other law, rule, or regulation to the contrary, for the 
purpose of expediting the procurements, the following provisions shall apply as 
modifications to law or regulation that may interfere with the expedited award 
of the above services:

���� (1)�� the timeframes for 
challenging the specifications shall be modified as determined by the division;

���� (2)�� in lieu of advertising 
in accordance with sections 2, 3, and 4 of P.L.1954, c. 48 (C.52:34-7, 
C.52:34-8, and C.52:34-9), the division shall advertise the request for 
proposals for the above services and any addenda thereto on the division�s 
website;

���� (3)�� the period of time that 
the State Comptroller has to review the request for proposals for these 
professional services procurements for compliance with applicable public 
contracting laws, rules and regulations, pursuant to section 10 of P.L.2007, 
c.52 (C.52:15C-10), shall be 10 business days or less if practicable, as 
determined by the State Comptroller;

���� (4)�� the timeframes for 
submission under section 1 of P.L.1977, c.33 (C.52:25-24.2) and section 4 of 
P.L.2012, c.25 (C.52:32-58) shall be extended to prior to the issuance of a 
Notice of Intent to Award;

���� (5)�� the provisions of 
section 1 of P.L. 2005, c.92 (C.52:34-13.2) shall not apply to technical and 
support services, under this section, provided by a vendor using a �24/7 
follow-the-sun model� as long as the contractor is able to provide such 
services in the United States during the business day; and

���� (6)�� the term �bids� in 
subparagraph (f) of subsection a. of section 7 of P.L.1954, c.48 (C.52:34-12) 
shall not include pricing which will be revealed to all responsive bidders 
during the negotiation process.

���� d.� The division may, to the 
extent necessary, waive or modify any other law or regulation that may 
interfere with the expeditious procurement of these services.

���� e.� Not later than 60 days 
following the award of the pharmacy benefits manager contract for the State 
Health Benefits Program and the School Employees� Health Benefits Program, the 
division shall submit a report to the Governor, and to the Legislature pursuant 
to section 2 of P.L.1991, c.164 (C.52:14-19.1), summarizing the results of the 
reverse auction, the realized savings resulting from the procurement of the 
services required under subsection b. of this section, the procedural 
deviations taken by the division during the procurement process, and 
information deemed necessary by the division to increase accountability and 
oversight of the