New Jersey and Federal Legislative Update

For more information about this blog post, please contact Khaled J. KleleLatoya Caprice Dawkins, or Ryan M. Magee.

New Jersey Statutes:

A3717 – Approved – We previously reported on this statute, which initially passed both houses, but was then vetoed by the Governor.  After some modifications, the statute passed both houses again and became law after excluding self-insured plans, the State Health Benefits Plan, and the School Employees Health Benefits Plan.  The statute prohibits a pharmacy benefits manager from retroactively reducing payments on a properly filed claim for payment by a pharmacy.  These retroactive reductions in payments are referred to as direct and indirect remuneration (DIR) fees.  When a pharmacy adjudicates a claim at the point of sale, the reimbursement amount provided to the pharmacy by the pharmacy benefits manager constitutes a final reimbursement amount.  However, there are exceptions.  For example, a pharmacy benefits manager may recoup funds as the result of an audit, performed pursuant to a contract between the pharmacy benefits manager and the pharmacy.  In addition, the statute requires, with respect to execution, renewals, and changes in terms of a contract between a pharmacy benefits manager and a pharmacy, more information to be disclosed to the pharmacy in the contract, and a reasonable process by which contracted pharmacies can access certain pricing information.  Importantly, besides providing certain appeal rights, the statute provides that a pharmacy benefits manager may not terminate a pharmacy licensed in the State of New Jersey solely on the basis that the pharmacy offers and provides store direct delivery and mail prescriptions to an insured as an ancillary service.

A5098 – Approved – This statute passed both houses and became law.  We previously reported on this statute, which attempted to establish a $25 hourly Medicaid reimbursement rate for personal care services, but was vetoed by the Governor.  The amended bill establishes an $18 hourly rate instead. 

A1582 – Passed – This statute, which passed both houses, is titled the “Dietetics and Nutrition Licensing Act” and provides for the licensure of nutritionists and dietitian nutritionists.  As part of the Act, a seven-member State Board of Dietetics and Nutritionists will be created in the Division of Consumer Affairs.

A2431 – Passed – After passing both houses, this statute requires health insurers, under certain policies or contracts that provide coverage for prescription drugs, to place limitations on covered persons’ cost sharing for prescription drugs.  Unless an exception applies, the statute requires insurers that offer plans in the individual and small employer markets to ensure that at least 25 percent of all plans, or at least one plan if the insurer offers less than four plans, offered by the insurer in each rating area and in each of the bronze, silver, gold, and platinum levels of coverage, shall provide the following: (1) a contract that provides a silver, gold, or platinum level of coverage shall limit a covered person’s cost-sharing financial responsibility, including any copayment or coinsurance, for prescription drugs, including specialty drugs, to no more than $150 per month for each prescription drug for up to a 30-day supply of any single drug; and (2) a contract that provides a bronze level of coverage shall ensure that any required covered person’s cost-sharing, including any copayment or coinsurance, does not exceed $250 per month for each prescription drug for up to a 30-day supply of any single drug.

A5509 – Passed – This statute passed both houses and requires health benefits and Medicaid coverage, without requiring any cost sharing, for comprehensive lactation support and counseling and consultation, and the costs for renting or purchasing electric or manual breastfeeding equipment, in conjunction with each birth, for the duration of breastfeeding for health plan enrollees.

A4608 – Passed – This statute passed both houses and establishes and provides for the regulation and licensing of applied behavior analysts. It also establishes the State Board of Applied Behavior Analyst Examiners in the Division of Consumer Affairs Certified Behavior Analysts.

S2133 – Passed – This statute, after passing both houses, requires health insurers to provide health benefits coverage for standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility defined as an impairment of fertility caused by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.  For example, the statute requires that the provision of standard fertility preservation services must not be determined based on a covered person’s expected length of life, present or predicted disability, degree of medical dependency, perceived quality of life, or other health conditions, or based on personal characteristics, including age, sex, sexual orientation, marital status, or gender identity.   The bill defines standard fertility preservation services as procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or as defined by the New Jersey Department of Health, but does not include storage of sperm or oocytes. 

S2389 – Passed – This statute requires the New Jersey State Board of Pharmacy to establish a prescription drug pricing disclosure website.  The Board is required to develop a prescription drug pricing disclosure website to make prescription drug price information available to New Jersey practitioners.  The website must include, at a minimum, the following data elements, separated by therapeutic category:  (1) name of the product; (2) whether the drug is brand name or generic; (3) drug strength; (4) per-unit wholesale acquisition cost of the drug, provided to the Board by pharmaceutical manufacturing companies as required by the bill; and (5) any disclaimers deemed appropriate by the Board that are not inconsistent with State and federal law or regulations. 

S4141 – Passed – This statute, which passed both houses, provides that the parent or guardian of a student who seeks epilepsy or seizure disorder care while at school annually submit a seizure action plan to the school nurse. 

Federal Regulations:

84 FR 71674 – Final Rule – This final rule revises standards relating to oversight and operations of the Exchanges established by states under the Affordable Care Act and periodic data matching frequency. This final rule is effective February 25, 2020.

84 FR 70139 – Proposed – The DOH issued a proposed rule amending the regulations implementing the National Organ Transplant Act of 1984 to remove financial barriers to organ donation by expanding the scope of reimbursable expenses incurred by living organ donors to include lost wages and child-care and elder-care expenses incurred by a primary care giver. Comments are due by February 18, 2020.

84 FR 70628 – Proposed Rule – CMS issued a proposed rule related to the Conditions for Coverage for Organ Procurement Organizations (OPOs) in the hopes of increasing organ donations. OPOs perform several tasks related to organ procurement, including identifying potential organ donors, recovering the organs from donors, evaluating the organs, and supporting donor families. The proposed rule would increase the performance of OPOs based on various metrics, such as, including a “donation rate measure,” which would use objective, transparent, and reliable data to establish donor potential in a given area, changes to the transplantation rate measure, increased monitoring related to these outcomes measures, and performance benchmarks based on top-performing OPOs. Comments are due by February 21 , 2020.