President
James Vizzoni, R.Ph.
CEO
John A. GiampoloDir of Gov’t & Public Affairs
Anthony Reznik /
Government Affairs Division
Legislative Updates
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To:IPA NJ MembersFrom: Anthony Reznik June 21, 2017
NJ Bill Prohibit PBM Retroactive Reductions in Payments
Working with the independent community pharmacy coalition, Assemblyman Raj Mukherji introduced Assembly bill 5041 (A5041) which would prohibit PBMs from retroactively reducing payment on properly filed claims. This process makes it difficult for pharmacies to operate with predictable revenues. A5041 does not apply to Medicare claims. New Jersey state law cannot regulate Medicare Part D. A5041 is being referred to a legislative committee for consideration.
New Jersey State Legislative Updates
- Committee Approves A4676 State Regulation of PBMs:A4676 would require PBMs to register with the NJ Department of Banking and Insurance in order to operate in the state. PBMs have complete oversight of prescription drug management, including formulary development and network design, PBMs must be regulated by the state in order to protect independent pharmacies and patients from abuses. The bill provides patients and their pharmacies the ability to resolve complaints and gives the state the power to exert reforms and oversight of PBMs operating in New Jersey. The bill was approved by the Assembly Insurance Committeeon June 1stand is awaiting consideration in the Assembly.(Support)
- S3143 Pharmacy Audit Bill of Rights:Too often PBM auditors, some of whom are paid based on the number of discrepancies found, go beyond the basic intent of the audit (to detect fraud, waste and abuse) and instead focus on typographical or administrative errors which they use as the basis to recoup money from the pharmacy. S3143 establishes reasonable protections for pharmacies such as providing14 days advance written notice of the audit and clerical errors shall not be deemed fraudulent in the absence of any financial harm or other evidence. S3143 is pending in Senate Commerce Committee. (Support)
- S2795 Provides Insurers Access to Prescription Monitoring Program (PMP): Would provide NJ Medicaid and private insurers the ability to access PMP for the purpose of identifying whether a beneficiary is obtaining a controlled dangerous substance in a manner that may be indicative of misuse. We worked with Senator Patrick Diegnan on amendments to the bill that will prevent PBMs from using PMP as a tool to impose fines/penalties on independent pharmacies.S2795 is waiting to be voted on by the Senate.(Monitoring)
- S295 New Law Will Allow Pharmacies to Dispense Opioid Antidote without Rx:On June 9th a new law was approvedthat authorizes pharmacists to supply opioid antidotes to patients without prescriptions. The NJ Department of Health (DOH) is required to issue a standing order authorizing pharmacists to dispense opioid antidotes to patients without individual prescriptions. The law is permissive and does not require pharmacists to supply opioid antidotes. IPA will provide more information on guidance for pharmacists and the pending standing order as it becomes available.(Support)
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