TRENTON - Legislation introduced by Senator Vin Gopal that would ban the abusive practice of pharmacy benefits manager (PBMs) "clawbacks" was approved by the Assembly today, and now heads to the Governor for final approval.
"This abusive practice of paying for prescriptions and then retroactively reducing the payment several months afterward does extensive damage, disrupting pharmacies' revenue streams and turning reliability into uncertainty," said Gopal (D-Long Branch). "By banning these tactics, we can drive down the costs of prescription medication and make our system work for patients, not middlemen."
Under this bill (S-728), a PBM would be prohibited from retroactively reducing payment on a properly filed claim for payment by a pharmacy. The bill also requires, with respect to execution, renewals, and changes in terms of a contract between a pharmacy benefits manager and a pharmacy, more information to be disclosed to the pharmacy in the contract, and a reasonable process by which contracted pharmacies can access certain pricing information.
The bill also makes additional reforms to PBM contracts and policies, including new protections for pharmacies against harmful or opaque PBM policies alongside new standards for oversight and transparency.
"It's time to even the playing field, restoring transparency, fairness, and oversight to our struggling healthcare industry," Gopal added. "This legislation is a big step on the path forward, and I'm determined to keep fighting for affordable and quality healthcare for all of our Monmouth County residents."