Rutgers Law

New Jersey Statutes, Title: 17B, INSURANCE

    Chapter 27f: Pharmacy Benefits Managers

      Section: 17B:27f-9.1: Carrier, health benefits plan, access data, administration, provision, prescription drug benefits; penalties.

          8. a. A carrier or health benefits plan, including the State Health Benefits Program, the School Employees' Health Benefits Program, the State Medicaid program, and a self-insured health benefits plan governed by the provisions of the federal "Employee Retirement Income Security Act of 1974," 29 U.S.C. s.1001 et seq., shall have the ability to access all data related to the administration and provision of prescription drug benefits administered by a pharmacy benefits manager under the health benefits plan, including, but not limited to:

(1) the names, addresses, member identification numbers, protected health information and other personal information of covered persons; and

(2) any contracts, documentation, and records, including transaction and pricing data and post point-of-sale information, related to the dispensing of prescription drugs to covered persons under the health benefits plan.

b. A sale or transaction involving the transfer of any records, information or data described in subsection a. of this section must comply with the federal Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, and the federal Health Information Technology for Economic and Clinical Health Act, Pub. L. No. 111-5, and any regulations adopted pursuant to those laws.

c. A carrier or health benefits plan, including the State Health Benefits Program, the School Employees' Health Benefits Program, the State Medicaid program, or a self-insured health benefits plan may audit all transaction records related to the dispensing of prescription drugs to covered persons under a health benefits plan. A carrier or health benefits plan, including the State Health Benefits Program, the School Employees' Health Benefits Program, the State Medicaid program, or a self-insured health benefits plan may conduct audits at a location of its choosing and with an auditor of its choosing.

d. A carrier shall maintain all records, information and data described in subsection a. of this section and all audit records described in subsection c. of this section for a period of no less than five years.

e. (1) Upon request, a carrier or pharmacy benefits manager shall provide to the department any records, contracts, documents or data held by the carrier or the carrier's pharmacy benefits manager for inspection, examination or audit purposes. The department shall keep confidential all information submitted pursuant to this section and shall protect it from public disclosure. Any records, documents, or data provided to the department pursuant to this subsection shall not be considered a government record under P.L.1963, c.73 (C.47:1A-1 et seq.) or the common law concerning access to government records.

(2) A person who is authorized to access information submitted by a pharmacy benefits manager to the department who willfully discloses such information to any person or entity who is not authorized to access the information shall be subject to a civil penalty in an amount not to exceed $500.

A civil penalty imposed under this subsection shall be collected by the commissioner pursuant to the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.).

f. A pharmacy benefits manager shall disclose in writing to a carrier or health benefits plan any activity, policy, practice, contract or arrangement of the pharmacy benefits manager that directly or indirectly presents any conflict of interest with the pharmacy benefits manager's relationship with or obligation to the carrier or plan.

L.2023, c.107, s.8.

This section added to the Rutgers Database: 2023-10-20 18:06:47.

Older versions of 17b:27f-9.1 (if available):

Court decisions that cite this statute: CLICK HERE.