New Jersey S 2345: "Patient and Provider Protection Act."

Bill Text

S2345 

SENATE, No. 2345 

STATE OF NEW JERSEY

222nd LEGISLATURE

� 

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Senator JOHN F. MCKEON

District 27 (Essex and Passaic)

Senator� VIN GOPAL

District 11 (Monmouth)

Co-Sponsored by:

Senators McKnight, Burzichelli, Moriarty, Tiver, Singleton, 
Mukherji, Cruz-Perez, Turner and Steinhardt

SYNOPSIS

���� "Patient and Provider Protection Act."

CURRENT VERSION OF TEXT 

���� Introduced Pending Technical Review by Legislative 
Counsel.

�� 

An Act concerning pharmacy benefits managers, amending P.L.2023, 
c.107, 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.��� Section 7 of P.L.2023, 
c.107 (C.17B:27F-3.3) is amended to read as follows:

���� 7. a. A carrier, or a pharmacy 
benefits manager under contract with a carrier, shall establish a pharmacy and 
therapeutics committee responsible for managing the formulary system.

���� b.��� A carrier, or a pharmacy 
benefits manager under contract with a carrier, shall not allow a person with a 
conflict of interest to be a member of its pharmacy and therapeutics 
committee.� 

���� A carrier, or a pharmacy 
benefits manager under contract with a carrier, shall require that its pharmacy 
and therapeutics committee meet the requirements for conflict of interest as 
set by the Centers for Medicare and Medicaid Services or meets the accreditation 
standards of the National Committee for Quality Assurance or another 
independent accrediting organization.

���� c.��� A pharmacy and 
therapeutics committee shall ensure that no decision concerning the inclusion 
of a prescription drug in a formulary system, or in a particular tier of the 
formulary system, places a prescription drug with a higher cost in a more 
favorable position than a generic or biosimilar prescription drug with a lower 
cost.

(cf: P.L.2023, c.107, s.7)

���� 2.��� Section 9 of P.L.2023, 
c.107 (C.17B:27F-3.4) is amended to read as follows:

���� 9. a. If a carrier uses a 
pharmacy benefits manager to administer or manage the prescription drug 
benefits of covered persons, any pharmacy benefits manager compensation, for 
purposes of calculating a carrier's anticipated loss ratio or any loss ratio calculated 
as part of any applicable medical loss ratio filing or rate filing, shall: 

���� (1) constitute an 
administrative cost incurred by the carrier in connection with a health 
benefits plan; and

���� (2) not constitute a benefit 
provided under a health benefits plan.� A carrier shall claim only the amounts 
paid by the pharmacy benefits manager to a pharmacy or pharmacist as an 
incurred claim.

���� b.��� Any rate filing 
submitted by a carrier with respect to a health benefits plan that provides 
coverage for prescription drugs or pharmacy services and that is administered 
or managed by a pharmacy benefits manager shall include:

���� (1) a memorandum prepared by a 
qualified actuary describing the calculation of the pharmacy benefits manager 
compensation; and

���� (2) any records and supporting 
information as the department reasonably determines is necessary to confirm the 
calculation of the pharmacy benefits manager compensation.

���� c.��� Upon request, a carrier 
shall provide any records to the department that relate to the calculation of 
the pharmacy benefits manager and pharmacy services administrative organization 
compensation.

���� d.��� A pharmacy benefits 
manager and pharmacy services administrative organization shall provide any 
necessary documentation requested by a carrier that relates to pharmacy 
benefits manager compensation in order to comply with the requirements of this 
section.

���� e.��� Compensation to a 
pharmacy benefits manager shall be in a flat fee arrangement.� No pharmacy 
benefits manager shall receive compensation in any form of commission 
structure.

(cf: P.L.2023, c.107, s.9)

���� 3.��� (New section)� a.� A 
pharmacy benefits manager shall have a fiduciary duty to the long term health 
outcomes of covered persons.

���� b.��� A pharmacy benefits 
manager shall not engage in any marketing activity that uses inaccurate or 
misleading information to convince or attempt to convince covered persons to 
use a contracted or network pharmacy.

���� 4.��� (New section)� An 
agreement between a pharmacy benefits manager and a manufacturer shall not be 
valid if the contract conditions any rebate on the exclusion of generic drugs 
from coverage.

���� 5.��� (New section)� a.� A 
contract between a pharmacy benefits manager and a contracted pharmacy or 
network pharmacy shall, in the event of a dispute, be presumed to be a 
�contract of adhesion.�

���� b.��� A pharmacy benefits 
manager shall, for a prescription drug, reimburse:

���� (1)� a contracted pharmacy or 
a network pharmacy at a rate that is at least equal to the pharmacy�s cost of 
acquiring the prescription drug; and

���� (2)�