N.J. Admin. Code § 13:45K-1.5

Current through Register Vol. 56, No. 24, December 18, 2024

Section 13:45K-1.5 - Pharmacy benefits manager reporting

(a) The Division shall notify a pharmacy benefits manager annually of the specific drugs or drug groups for which reporting is required. Within 60 days, the pharmacy benefits manager shall report to the Division the information at N.J.S.A. 45:14-82.4.a and any other data requested by the Division to make clear the major components of prescription drug pricing, along the supply chain, and the impacts on insurance premiums and consumer cost sharing pursuant to the Data Collection Manual.

(b) A pharmacy benefits manager shall certify the reporting pursuant to this section as accurate and complete under penalty of perjury, including reporting on its behalf by subsidiaries, employees, contractors, or any third parties.

(c) The Division shall consider the following factors in determining the specific drugs or drug groups for which reporting is required:

1. Information from other reporting entities, including without limitation, drugs that are the subject of:

i. Manufacturer notification of price increases and introduction of new drugs or biosimilars pursuant to N.J.S.A. 45:14-82.3; and

ii. Reporting by carriers pursuant to N.J.S.A. 45:14-82.6;

2. Whether the drug is listed on the New Jersey Prescription Drug Price Registry available at https://www20.state.nj.us/LPSCA_DRUG/ due to the frequency with which it is prescribed;

3. Historical prices and price increases;

4. Whether there are alternatives to the drug and, if so, their cost and availability;

5. Whether the drug appears on the current Model List of Essential Medicines or Essential Medicines List for Children adopted by the World Health Organization available at https://www.who.int/groups/expert-committee-on-selection-and-use-of-essential-medicines/essential-medicines-lists;

6. The drug's efficacy in treating a life-threatening health condition or a chronic condition that substantially impairs the person's ability to engage in activities of daily living; and

7. Any other information relevant to making clear the major components of prescription drug pricing along the supply chain and the impacts on insurance premiums and consumer cost sharing.

N.J. Admin. Code § 13:45K-1.5

Adopted by 56 N.J.R. 2246(a), effective 10/15/2024