Healthcare (Prescription Drugs) in New Jersey

in committee · New Jersey · General Assembly Jun 15, 2026

A 5270: Requires coverage of clinician-administered drugs without additional financial penalties or certain limitations on location of administration of drugs.

This New Jersey bill requires health insurance plans and pharmacy benefit managers to cover drugs that must be administered by a clinician without charging patients extra fees or imposing special restrictions. It prohibits insurers from refusing to pay for these medications, forcing patients to use specific pharmacies, or penalizing them with higher copays simply because they receive care at a doctor's office or hospital rather than a pharmacy. Additionally, the law prevents insurers from denying coverage based on where the drug is administered, as long as it meets standard medical necessity criteria. While the bill allows insurers to suggest using home infusion services or external infusion sites, it does not make these options mandatory.

Topics ✓ Healthcare

Sub-Topics Hospitals Insurance Prescription Drugs

in committee · New Jersey · General Assembly Jun 15, 2026

A 5285: "Public School Employees' Health Benefits Trust Act."

This bill establishes a new trust fund to provide health benefits, including medical, pharmacy, dental, and vision coverage, to eligible public school employees and their dependents in New Jersey. It defines who qualifies as an employee and dependent, specifying that full-time workers must work at least 25 hours per week and that dependents include spouses, domestic partners, and unmarried children up to age 31. The legislation creates a board of trustees to manage the fund and ensure its assets are used solely for the benefit of the covered individuals. Additionally, the bill includes an appropriation to fund the initial operations of this new trust.

Topics ✓ Budget & Taxes ✓ Education ✓ Healthcare ✓ Labor & Employment

Sub-Topics Appropriations Prescription Drugs

in committee · New Jersey · Senate Jun 22, 2026

S 4501: Requires DOBI to establish all-payer claims database.

This bill requires New Jersey's Department of Banking and Insurance to create a centralized all-payer claims database. The system will collect and store data on medical, prescription drug, dental, and vision claims from insurance companies, hospitals, and other healthcare providers. Key provisions mandate that the department securely manage this information, conduct audits to verify accuracy, and publish the data on a public dashboard for transparency. The law applies to nearly all health plans in the state but excludes specific types of coverage such as accident-only policies and Medicare supplements.

Topics ✓ Healthcare ✓ Technology

Sub-Topics Medicare Prescription Drugs

in committee · New Jersey · Senate Jun 8, 2026

S 4438: "Public School Employees' Health Benefits Trust Act."

This bill creates a new trust fund to provide health benefits, including medical, pharmacy, dental, and vision coverage, to public school employees and their dependents in New Jersey. It establishes a board of trustees to manage the fund and defines eligibility to include full-time employees working at least 25 hours a week and their spouses, domestic partners, and unmarried children up to age 31. The legislation also clarifies that dependents who enlist in the military are not covered during their service and gives the board final authority on determining employee and dependent status.

Topics ✓ Education ✓ Healthcare ✓ Labor & Employment

Sub-Topics Prescription Drugs

in committee · New Jersey · General Assembly May 7, 2026

A 5012: Requires certain standards be established for contracts between pharmacy benefits managers and health benefits plans.

This bill requires health benefits plans in New Jersey to allow any pharmacy that meets standard contract terms to participate in their network when pharmacy benefits managers are involved. It mandates that contract terms between these entities be reasonable and relevant, with the state Commissioner of Banking and Insurance responsible for defining these standards by reviewing current agreements and ensuring reimbursement fees cover operational costs. The law applies to contracts initiated or renewed after its enactment, which is set to take effect thirteen months after introduction.

Topics ✓ Healthcare

Sub-Topics Prescription Drugs

in committee · New Jersey · General Assembly May 7, 2026

A 5020: Prohibits pharmacy benefit manager from using spread pricing as model of prescription drug pricing; requires transparency in provision of pharmacy benefits management services.

This bill prohibits pharmacy benefit managers in New Jersey from using spread pricing, a model where patients pay more at the pharmacy counter than the plan's negotiated rate, and requires full transparency in how these companies are compensated. Under the new rules, any rebates or fees received by these managers must be passed entirely to the health plan or carrier, while the managers can still charge a standard administrative fee for their services. The legislation also mandates that carriers closely monitor the managers' activities and ensures that patients never pay more at the point of sale than they would if they bought the medication without insurance. To enforce these changes, pharmacy benefit managers must submit detailed financial statements and audits to the state department on a quarterly and annual basis, and the department will publish a yearly report on how these pricing practices affect overall health plan costs.

Topics ✓ Healthcare

Sub-Topics Insurance Prescription Drugs

in committee · New Jersey · Senate May 11, 2026

S 4208: Prohibits pharmacy benefit manager from using spread pricing as model of prescription drug pricing; requires transparency in provision of pharmacy benefits management services.

This New Jersey bill prohibits pharmacy benefit managers from using spread pricing, a practice where patients pay more at the pharmacy counter than the actual cost of the drug. Instead, the law requires these managers to pass 100% of rebates and fees directly to insurance carriers or purchasers while allowing them to charge standard administrative fees for their services. The legislation also mandates greater transparency by requiring pharmacy benefit managers to submit detailed financial statements and audits to state officials. Additionally, it ensures that patients never pay more out-of-pocket for a prescription than they would if they bought the medication without insurance.

Topics ✓ Healthcare

Sub-Topics Prescription Drugs

in committee · New Jersey · General Assembly May 7, 2026

A 4948: Prohibits pharmacy benefits managers from operating pharmacy practice sites directly or indirectly.

This bill prohibits pharmacy benefits managers from owning or operating pharmacy practice sites in New Jersey to prevent conflicts of interest and promote fair competition. It requires the state pharmacy board to identify and notify any pharmacies that might violate this rule before July 1, 2027, allowing affected businesses to transition to independent ownership. The legislation includes a temporary exception allowing special permits for pharmacies to dispense rare or limited-distribution drugs that are otherwise unavailable, with this provision expiring on September 1, 2028. Ultimately, the law aims to increase patient choice and lower drug prices by separating the entities that set prescription prices from those that sell medications.

Topics ✓ Healthcare

Sub-Topics Prescription Drugs

in committee · New Jersey · Senate May 11, 2026

S 4205: Requires pharmacy benefits manager compensation to be based on bona fide service fee.

This New Jersey bill requires pharmacy benefits managers to be paid only a flat, itemized service fee rather than commissions tied to drug prices or sales volume. The law directly affects insurance carriers, pharmacy benefits managers, and the state's Department of Banking and Insurance by mandating that compensation reflect the fair market value of actual services provided. Under the new rules, managers cannot receive fees based on drug costs, rebates, or the number of prescriptions filled, and carriers must submit detailed documentation to verify these payments. The legislation aims to ensure that administrative fees are transparent and not passed on to patients through inflated drug pricing.

Topics ✓ Healthcare

Sub-Topics Prescription Drugs

in committee · New Jersey · Senate May 11, 2026

S 4206: Requires pharmacy benefits managers to make certain disclosures to health benefits plan sponsors.

This New Jersey bill requires pharmacy benefits managers to provide health plan sponsors with detailed financial reports every six months. The legislation mandates that these reports include specific data on drug costs, rebates, and out-of-pocket spending for each prescription filled through different channels like retail or mail order. By demanding this information in plain language and machine-readable formats, the bill aims to increase transparency regarding how much money is exchanged between drug manufacturers, pharmacies, and insurance plans. Ultimately, the law seeks to help plan sponsors better understand the financial details of their pharmacy benefits contracts.

Topics ✓ Healthcare

Sub-Topics Insurance Prescription Drugs

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