A 5388 — Establishes "Medicaid Pharmacy Benefit Transparency and Accountability Act."

Summary

Medicaid Pharmacy Benefit Transparency & Accountability Act-establish

Bill Text

• Introduced View text Current html September 11, 2026

AI-generated reading aid from the bill's amendatory text — verify against the official bill.

This bill amends 1 section(s) of the New Jersey statutes: N.J.S.A. 30:4D-7ee.

• N.J.S.A. 30:4D-7ee

  and → ; (4) any information necessary for the State Auditor to conduct an audit required pursuant to section 3. of P.L. , c. (C. ) (pending before the Legislature as this bill), including, but not limited to, claims-level data and the terms of any contract or other arrangement entered into by a managed care organization, or the division for the provision of pharmacy benefits management services; and (5) any ownership interest or affiliation with a contracted pharmacy, which information the division shall review to identify any conflicts of interest or anti-competitive practices in connection with the performance of pharmacy benefits management services "Steering" means a practice employed by a pharmacy benefit manager that channels a prescription to an affiliated pharmacy, or pharmacy in which a pharmacy benefits manager or carrier has an ownership interest, and includes, but is not limited to, retail, mail-order, or specialty pharmacies. d. Any contract or other arrangement entered into by a managed care organization, or by the Division of Medical Assistance and Health Services in the Department of Human Services, for the provision of pharmacy benefits management services under the Medicaid program shall: (1) require the pharmacy benefits manager to: (a) remit to the division all manufacturer rebates, fees, and other renumerations received by the pharmacy benefits manager; (b) provide an internal appeal mechanism to resolve any dispute raised by the division or managed care organization or pharmacy concerning drug pricing. Any dispute regarding the determination of an internal appeal conducted pursuant to this paragraph may be referred to arbitration. The division shall contract with a nationally recognized, independent organization that specializes in arbitration to conduct the arbitration proceedings; and (c) meet standards and practices used in the creation of pharmacy networks and contracting with network pharmacies and other providers, including the promotion and use of independent and community pharmacies and patient access and minimizing excessive concentration and vertical integration of markets; (2) prohibit the pharmacy benefits manager from engaging in the practice of steering; and (3) in the case of the termination of a contracted pharmacy, permit a Medicaid beneficiary to continue receiving prescription drug services from the pharmacy for a period of not less than 90 days from the date of the termination, which period shall be determined by the division.

  amended

Action History

1. September 10, 2026

   INT 1RA REF AHU

Sponsors

• Heather Simmons · Primary

Subjects