Bill

A 4810

Relates to the application of certain provisions relating to commercial financing

2025 Regular Session Introduced by Chris Burdick and 4 co-sponsors

Requires NJ FamilyCare to reimburse licensed clinical pharmacists for comprehensive medication management of medically complex pediatric patients, under value-based contracts.

REFERRED TO BANKS

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Bill Summary · A 4810

Legislative Bill Summary – Assembly Bill No. 4810 (A-4810)

Overview and Purpose

A-4810 would require New Jersey FamilyCare (the state’s Medicaid program) to reimburse comprehensive medication management (CMM) services provided by licensed clinical pharmacists for medically complex pediatric patients. The bill defines CMM as a coordinated process where a clinical pharmacist evaluates all of a child’s medications (prescription, over-the-counter, vitamins, and supplements) to ensure appropriateness, safety, and effectiveness within the context of the patient’s conditions and other medications. The aim is to improve medication optimization for medically complex children through team-based care.

Key Provisions

Reimbursement for CMM: NJ FamilyCare must reimburse licensed clinical pharmacists for CMM services delivered to medically complex pediatric patients.
Definition of Clinical Pharmacist: A licensed pharmacist who has completed a clinical residency and works as part of the patient’s health care team to provide medication therapy evaluations and recommendations.
Scope of CMM Services:
- Comprehensive review of all medications and supplements
- Development and implementation of patient-specific medication action plans
- Ongoing monitoring of adherence to the plan
- Follow-up consultations to ensure efficacy and safety
- Additional CMM services as deemed necessary by the Division of Medical Assistance and Health Services (DMHAS) and the Board of Pharmacy
Value-Based Contracts: DMHAS would enter into value-based contracts with licensed clinical pharmacists to reimburse these services and would establish a quality assurance program to monitor outcomes and alignment with value-based payment strategies.
Credentialing and Education: The Division of Medical Assistance and Health Services and the Board of Pharmacy would designate the educational, training, and credentialing requirements for pharmacists providing CMM.
Pharmacy Practice Act Amendments:
- A licensed clinical pharmacist meeting credentialing requirements would not be required to enter into a written agreement with a physician to provide CMM services.
- Provisions regulating collaborative drug therapy management would not apply to the provision of CMM services by a licensed clinical pharmacist.

Fiscal and Administrative Impact

State Expenditures (NJ FamilyCare): Indeterminate annual increase in Medicaid-related costs due to reimbursements for CMM; exact amounts depend on contract terms.
Administrative Costs: Estimated increase in administrative costs to DMHAS and the Board of Pharmacy:
- Year 1: $607,000
- Year 2 and thereafter: $512,000
State Revenues: Potential federal Medicaid matching funds (assumed at 50% of total costs) could partially offset state expenditures:
- Year 1: approximately $303,500
- Year 2 and thereafter: approximately $256,000

The fiscal note notes that OLS could not determine exact program cost increases due to contractual reimbursement rates but expects some federal matching revenue.

Affected Entities and Beneficiaries

Beneficiaries: Medically complex pediatric patients enrolled in NJ FamilyCare.
Agencies:
- Department of Human Services (DMHAS)
- Board of Pharmacy (Division of Consumer Affairs)
- Potentially the Office of the Attorney General if related regulatory changes interact with pharmacy practice and Medicaid policies

Procedural Timeline and Status

Introduced: September 19, 2024
Committees:
- Assembly Health Committee (October 2024)
- Assembly Aging and Human Services Committee (February 2025)
- Senate Banks Committee (March 2025)
Legislative Actions:
- Assembly: Passed February–March 2025; delivered to Senate
- Senate: Referred to Banks (March 2025)
Related: Companion/Senate bills include S-4604; prior-session A-9463

Note

The bill advances a model that ties pharmacist-provided CMM to value-based payment structures and formal credentialing, while removing dependency on physician-written agreements or collaborative drug therapy management provisions for CMM services.

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