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Bill

A 5531

Establishes "Equitable Drug Pricing and Patient Access Act."

2024-2025 Regular Session Introduced by Joe Danielsen and 3 co-sponsors

The bill ensures fair Medicaid drug reimbursements, enhances pharmacy access for patients, and promotes transparency in pricing, benefiting both enrollees and pharmacies.

Introduced in the Assembly, Referred to Assembly Financial Institutions and Insurance Committee
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Bill Summary · A 5531

Summary of Bill A 5531: Equitable Drug Pricing and Patient Access Act

Bill Information:
- Bill Number: A 5531
- Title: Equitable Drug Pricing and Patient Access Act
- Status: Introduced in the Assembly, referred to Assembly Financial Institutions and Insurance Committee
- Introduced: April 10, 2025
- Sponsors:
- Assemblywoman Yvonne Lopez (District 19, Middlesex)
- Assemblywoman Margie Donlon, M.D. (District 11, Monmouth)
- Assemblywoman Luanne M. Peterpaul (District 11, Monmouth)

Purpose and Intent

The Equitable Drug Pricing and Patient Access Act aims to reform Medicaid reimbursement rates for prescription drugs in New Jersey. The bill seeks to enhance patient access to medications and ensure fair compensation for pharmacies participating in the Medicaid program. It addresses rising drug costs and aims to improve transparency and cost management within the Medicaid system.

Key Provisions

  1. Reimbursement Rates:

    • Establishes that reimbursement for prescription drug services must be at least equal to the national average drug acquisition cost plus a professional dispensing fee of $10.92.
    • Applies to both Medicaid fee-for-service and managed care systems.

  2. Pharmacy Choice:

    • Mandates that Medicaid managed care contracts include pharmacy choice as a required benefit.
    • Ensures that all pharmacies in New Jersey can dispense prescriptions for covered medications without restrictions based on cost or other criteria.
    • Outlines that pharmacies cannot be forced to dispense medications below their acquisition cost.

  3. Access to Providers:

    • Allows enrollees to choose any qualified pharmacy that is a contracting provider.
    • Guarantees that no pharmacy can be denied participation as a contracting provider if they accept the terms of the Medicaid managed care contract.

  4. State Audit:

    • Requires the State Auditor to conduct an audit of pharmacy pricing practices within the Medicaid program to assess potential savings from the bill's implementation.
    • The audit will track the flow of funds from managed care organizations to pharmacy benefit managers and pharmacies.

  5. Implementation:

    • The Commissioner of Human Services is tasked with applying for necessary state plan amendments or waivers to implement the bill.
    • The act will take effect on the first day of the seventh month following enactment and will apply to Medicaid managed care contracts executed thereafter.

Impact

  • Beneficiaries: The bill is expected to benefit Medicaid enrollees by improving access to a wider range of pharmacies and ensuring that they receive medications at fair prices.
  • Pharmacies: Pharmacies will have guaranteed reimbursement rates and the ability to participate in Medicaid managed care contracts without restrictive conditions.
  • State Budget: The audit aims to identify potential savings for the state, addressing the significant increase in Medicaid prescription drug spending, which rose from $2.1 billion in FY 2019 to $2.8 billion in FY 2024.

Conclusion

The Equitable Drug Pricing and Patient Access Act represents a significant step towards reforming Medicaid drug pricing in New Jersey, aiming to enhance patient access, ensure fair pharmacy compensation, and promote transparency in drug pricing practices. The bill is currently under consideration by the Assembly Financial Institutions and Insurance Committee.

Compiled from official sources — confirm details with the bill’s official record.

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