N.J. Admin. Code § 11:4-62.3

Current through Register Vol. 56, No. 21, November 4, 2024

Section 11:4-62.3 - Pharmacy benefits manager contracts

(a) Upon execution or renewal of each contract, a pharmacy benefits manager shall, with respect to contracts between a pharmacy benefits manager and a contracted pharmacy:

1. Include in the contract the sources utilized to determine multiple source generic drug pricing, including, if applicable, the maximum allowable cost or any successive pricing formula, of the pharmacy benefits manager;

2. Update that pricing information every seven calendar days; and

3. Establish a reasonable process by which contracted pharmacies have a method to access relevant maximum allowable cost pricing lists and any successive pricing formulas in a timely manner. Examples of such a process include: providing online access to the maximum allowable cost pricing, the sources thereof and the date of the last update of such pricing; providing such information through e-mail to contracted pharmacies; or, by similar means.

(b) A pharmacy benefits manager shall maintain a procedure to eliminate drugs from the list of drugs subject to multiple source generic drug pricing or modify maximum allowable cost rates in a timely fashion, but in no event any later than 15 days from the date of any change.

(c) In order to place a particular prescription drug on a multiple source generic list, the pharmacy benefits manager shall, at a minimum, ensure that:

1. The drug is listed as therapeutically and pharmaceutically equivalent or "A," "B," "NR," or "NA" rated in the Food and Drug Administration's most recent version of the Approved Drug Products with Therapeutic Equivalence Evaluations, commonly known as the "Orange Book"; and

2. The drug is available for purchase without limitations by all pharmacies in the State from national or regional wholesalers and is not obsolete or temporarily unavailable.

(d) A pharmacy benefits manager shall not penalize a pharmacist or pharmacy on audit if the pharmacist or pharmacy performs a generic substitution pursuant to the "Prescription Drug Price and Quality Stabilization Act," N.J.S.A. 24:6E-1 et seq.

N.J. Admin. Code § 11:4-62.3

Adopted by 50 N.J.R. 198(b), effective 1/2/2018