Rutgers Law

New Jersey Statutes, Title: 17B, INSURANCE

    Chapter 27f: Pharmacy Benefits Managers

      Section: 17B:27f-1.1: Pharmacy benefits manager, license, pharmacy services administrative, registration.

          2. a. A corporation, business, or other entity shall not act as a pharmacy benefits manager without first obtaining a license from the department or as a pharmacy services administrative organization without first obtaining registration from the department. An applicant for licensure or registration shall provide to the department information that includes, but is not limited to, the following:

(1) the name of the applicant;

(2) the address and telephone number of the applicant;

(3) the name and address of the applicant's agent for service of process in the State;

(4) the name and address of each person owning 10 percent or greater interest in the applicant;

(5) the name and address of each person with management or control over the applicant;

(6) for pharmacy benefits managers, the information required under section 4 of P.L.1999, c.409 (C.17:48H-4);

(7) for pharmacy benefits managers, all contracts and documents between pharmacies, pharmacy benefits managers, and pharmacy services administrative organizations; and

(8) for pharmacy services administrative organizations, upon the department's request, any contracts and documents between pharmacies, pharmacy benefits managers, and pharmacy services administrative organizations.

b. A license or registration issued pursuant to this section shall be valid for a period of three years and may be renewed at the end of the three-year period. The commissioner shall establish fees for a license or registration issued or renewed pursuant to this section.

c. The department may issue a pharmacy benefits manager license to an applicant only if the department is satisfied that the applicant possesses the necessary organization, expertise, and financial integrity to supply the services sought to be offered. The department shall establish, by regulation, minimum standards for the issuance of a license to a pharmacy benefits manager. The minimum standards established pursuant to this subsection shall contain both prerequisites for the issuance of a license to a pharmacy benefits manager and requirements for maintenance of a license by a pharmacy benefits manager and shall address, without limitation:

(1) conflicts of interest between pharmacy benefits managers and health benefits plans;

(2) deceptive practices in connection with the performance of pharmacy benefits management services;

(3) anti-competitive practices in connection with the performance of pharmacy benefits management services;

(4) unfair claims practices in connection with the performance of pharmacy benefits management services;

(5) pricing models used by pharmacy benefits managers both for their services and for the payment of services to the pharmacy benefits manager;

(6) standards and practices used in the creation of pharmacy networks and contracting with network pharmacies and other providers, including promotion and use of independent and community pharmacies and patient access and minimizing excessive concentration and vertical integration of markets; and

(7) protection of consumers.

d. The department may issue a license to a pharmacy benefits manager subject to restrictions or limitations, including the type of services that may be supplied or the activities in which the pharmacy benefits manager may engage.

e. A license or registration issued pursuant to this section shall not be transferable.

f. The department may suspend, revoke or place on probation a licensee or registered entity if:

(1) the pharmacy benefits manager or pharmacy services administrative organization has engaged in fraudulent activity or any activity that constitutes a violation of State or federal law;

(2) the department has received consumer complaints that justify an action under this subsection to protect the safety and interests of consumers;

(3) the pharmacy benefits manager or pharmacy services administrative organization fails to pay the original issuance or renewal fee for the license or registration; or

(4) the pharmacy benefits manager or pharmacy services administrative organization fails to comply with any requirement set forth in P.L.2023, c.107 (C.17B:27F-1.1 et al.).

g. If a corporation, business, or other entity acts as a pharmacy benefits manager or pharmacy services administrative organization without obtaining a license or registration pursuant to this section, the corporation, business, or other entity shall be subject to the provisions of section 7 of P.L.2019, c.274 (C.17B:27F-10).

h. (1) Notwithstanding the provisions of subsection a. of this section, a pharmacy benefits manager that applied for, or received, certification or licensure as an organized delivery system prior to the effective date of P.L.2023, c.107 (C.17B:27F-1.1 et al.), in accordance with P.L.1999, c.409 (C.17:48H-1 et seq.), may continue to operate during the pendency of its application submitted pursuant to this section, but no more than 24 months after the effective date of this act.

(2) A corporation, business, or other entity that acts as a pharmacy benefits manager, and applies for, receives, and maintains a license as an organized delivery system, in accordance with P.L.1999, c.409 (C.17:48H-1 et seq.), shall not be required to maintain that license as an organized delivery system upon the issuance of a license pursuant to P.L.2023, c.107 (C.17B:27F-1.1 et al.), and during any subsequent applications for renewal of the license as a pharmacy benefits manager pursuant to the requirements of P.L.2023, c.107 (C.17B:27F-1.1 et al.).

i. A licensee shall be subject to the following except to the extent inconsistent with this act or where the commissioner determines that any provisions are inappropriate as applied to a pharmacy benefits manager:

(1) the unfair trade practices provisions of N.J.S.17B:30-1 et seq.;

(2) the provisions of P.L.1970, c.22 (C.17:27A-1 et seq.);

(3) the "Life and Health Insurers Rehabilitation and Liquidation Act," P.L.1992, c.65 (C.17B:32-31 et seq.);

(4) investment limitations pursuant to N.J.S.17B:20-1 et seq.; and

(5) the "Health Care Quality Act," P.L.1997, c.192 (C.26:2S-1 et al.).

L.2023, c.107, s.2.

This section added to the Rutgers Database: 2023-10-20 18:06:24.

Older versions of 17b:27f-1.1 (if available):

Court decisions that cite this statute: CLICK HERE.