Sponsored by:
Assemblywoman HEATHER SIMMONS
District 3 (Cumberland, Gloucester and Salem)
SYNOPSIS
Requires Treasury to regularly review contract and performance of pharmacy benefits manager for SHBP and SEHBP.
CURRENT VERSION OF TEXT
As introduced.
An Act requiring the Department of the Treasury to regularly review the contract and the performance of the pharmacy benefits manager for the State Health Benefits Program and the School Employees’ Health Benefits Program.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Beginning in the calendar year of the effective date of P.L. , c. (C. ) (pending before the Legislature as this bill), and every five calendar years thereafter, the Division of Pensions and Benefits in the Department of the Treasury shall conduct a formal review of the contract and the performance of the pharmacy benefits manager for the State Health Benefits Program.
b. The division shall consider the following during the formal review process:
(1) whether the contract for the pharmacy benefits manager is cost-effective and beneficial to the State and participating units of local government;
(2) whether the pharmacy benefits manager is meeting operational objectives;
(3) whether the pharmacy benefits manager is meeting financial objectives;
(4) the amount of annual net savings realized as a result of the contract and the performance of the pharmacy benefits manager; and
(5) any other factors that may be deemed necessary by the division to implement the provisions of this section.
c. Following the formal review process, the division shall publish a report summarizing the results of the formal review. The report shall include, but need not be limited to, the parameters of the review, the factors considered during the review, the cost impact of the contract and the performance of the pharmacy benefits manager to the State and participating units of local government during the review period, and any findings or conclusions realized as a result of the review.
The report shall be published online on the Internet website of the Division of Pensions and Benefits and made available to the public 30 days following the conclusion of the formal review process.
2. a. Beginning in the calendar year of the effective date of P.L. , c. (C. ) (pending before the Legislature as this bill), and every five calendar years thereafter, the Division of Pensions and Benefits in the Department of the Treasury shall conduct a formal review of the contract and the performance of the pharmacy benefits manager for the School Employees’ Health Benefits Program.
b. The division shall consider the following during the formal review process:
(1) whether the contract for the pharmacy benefits manager is cost-effective and beneficial to the State and participating education units of local government;
(2) whether the pharmacy benefits manager is meeting operational objectives;
(3) whether the pharmacy benefits manager is meeting financial objectives;
(4) the amount of annual net savings realized as a result of the contract and the performance of the pharmacy benefits manager; and
(5) any other factors that may be deemed necessary by the division to implement the provisions of this section.
c. Following the formal review process, the division shall publish a report summarizing the results of the formal review. The report shall include, but need not be limited to, the parameters of the review, the factors considered during the review, the cost impact of the contract and the performance of the pharmacy benefits manager to the State and participating education units of local government during the review period, and any findings or conclusions realized as a result of the review.
The report shall be published online on the Internet website of the Division of Pensions and Benefits and made available to the public 30 days following the conclusion of the formal review process.
3. This act shall take effect immediately.
STATEMENT
This bill requires the Department of the Treasury to regularly review the contract and performance of the pharmacy benefits manager for the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP).
Under the bill, beginning in the calendar year of the bill’s effective date and every five calendar years thereafter, the Division of Pensions and Benefits is required to conduct a formal review of the contract and the performance of the pharmacy benefits manager for the SHBP and the SEHBP.
During the review, the division is required to consider: whether the contract for the pharmacy benefits manager is cost-effective and beneficial to the State and participating units and education units of local government; whether the pharmacy benefits manager is meeting operational objectives; whether the pharmacy benefits manager is meeting financial objectives; and the amount of annual net savings realized as a result of the contract and the performance of the pharmacy benefits manager.
Following the review, the division is required to publish a report summarizing the results of the formal review on the Internet website of the division and made available to the public 30 days following the conclusion of the formal review process.