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Senate Commerce Committee Statement to Senate, No. 3818 (State of New Jersey, December 12, 2024)

Summary

Senate Commerce Committee statement to Senate, No. 3818, State of New Jersey, dated December 12, 2024. The committee reports favorably Senate Bill No. 3818, which prohibits health insurance carriers and pharmacy benefits managers in New Jersey from using accumulators. The statement says a carrier and a pharmacy benefits manager are required to give credit, when calculating an insured’s liability for coinsurance, copayment, deductible or other out-of-pocket expense, for any discount provided or payment made by a third party. It says the bill also amends the law regulating pharmacy benefits managers to widen the scope of pharmacy benefits management services and to modify what cost-sharing includes.

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“Senate Commerce Committee Statement to Senate, No. 3818 (State of New Jersey, December 12, 2024).” Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/2024-12-12-scm-s3818-s1-27ee60ab9e/, SHA-256 6a9d473a125aa488c698cf99788a2deb99a65b8bedb036c3303ee4ecf924540f.

Full text

     SENATE COMMERCE COMMITTEE

                    STATEMENT TO

                  SENATE, No. 3818

 STATE OF NEW JERSEY
                  DATED: DECEMBER 12, 2024

    The Senate Commerce Committee reports favorably Senate Bill
No. 3818.
    This bill prohibits health insurance carriers and pharmacy benefits
managers in New Jersey from using accumulators. Under the bill, a
carrier and a pharmacy benefits manager is required to give credit,
when calculating the liability of an insured for a coinsurance,
copayment, deductible, or other out-of-pocket expense for a covered
benefit, for any discount provided or payment made by a third party
for the amount of, or any portion of the amount of, the coinsurance,
copayment, deductible or other out-of-pocket expense for the covered
benefit. In the case of a high-deductible health plan, credit is to be
applied to the maximum extent permitted under federal law, or (1) to
the extent permitted under federal law and (2) in accordance with
certain stipulations in the Internal Revenue Code.
    The bill also amends the law regulating pharmacy benefits
managers to widen the scope of practice of pharmacy benefits
management services and to modify what cost-sharing includes.
Previous federal policy allowed health insurers to dismiss the use of
third-party discounts or coupons when the carrier calculated an
insured’s cost-sharing liability. Through this bill, New Jersey joins a
growing number of U.S. jurisdictions prohibiting insurers from
dismissing assistance received by covered persons to help pay their
share of cost-sharing to carriers.

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