To help reduce costs for New Jersey’s Medicaid program, Assembly Democrat Gary Schaer sponsors a bi-partisan bill requiring pharmacy benefits managers providing services within the Medicaid program to disclose certain information that would enhance transparency.
Pharmacy benefits managers (PBMs) serve as intermediaries between health insurance plans, prescription drug manufacturers and pharmacies – working to negotiate lower drug prices and process prescription claims.
However, some PBMs engage in ‘spread pricing,’ which is when they charge health insurance companies a higher price than what they paid to the pharmacy for a drug, since the PBM does not currently have to disclose how much was paid to the pharmacy for that medicine.
Under the bill (A-1259), PBMs providing services within the Medicaid program would be required to disclose information to the New Jersey Department of Human Services regarding the sources/amounts of income, payments and financial benefits they receive to provide services on behalf of health plans. This would include, but not be limited to, any pricing discounts, credits, rebates or reimbursements they receive.
PBMs would also be required to disclose any ingredient costs, dispensing fees or other similar payments made to a pharmacy, as well as their payment model for administrative fees.
Upon the Assembly Human Services Committee advancing the legislation Monday, Assemblyman Schaer (D-Bergen, Passaic) issued the following statement:
“Without transparency in our state regarding PBM pricing, health insurance plans like Medicaid may be charged far more than necessary to provide residents with the prescriptions they need. Requiring PBMs to disclose payments and benefits they receive for their services, how they implement fees, and more will help our state gain a better understanding of just how prevalent spread pricing is. From there, we can make more informed decisions about how to be more efficient and reduce health care costs on behalf of the more than 1.4 million residents covered by Medicaid.”
The bill now heads to the Assembly Speaker for further consideration.