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

Summary

The Senate Commerce Committee of the State of New Jersey, in a statement dated December 12, 2024, reports favorably Senate Bill No. 3818. The bill prohibits health insurance carriers and pharmacy benefits managers in New Jersey from using accumulators. A carrier or pharmacy benefits manager must credit any discount or third-party payment toward an insured's coinsurance, copayment, deductible or other out-of-pocket expense for a covered benefit. For a high-deductible health plan, credit is to be applied to the maximum extent permitted under federal law. The bill also amends the law regulating pharmacy benefits managers to widen the scope of pharmacy benefits management services.

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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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