45:14-82.6 Carrier, reporting entity, drug pricing, report, minimum data.
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/nj/title-45/chapter-14/45-14-82-6·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
5. a. A carrier designated by the division as a reporting entity shall report annually to the division, to the extent allowed by law, the spending on prescription drugs before enrollee cost sharing and enrollee cost sharing, in total and per prescription drug user, in total and for each of the top 25 prescription drugs and drug groups as defined by the division in the following categories:
(1)the greatest total spending before enrollee cost sharing in the last calendar year;
(2)the greatest total spending per user of any drug in the drug group before enrollee cost sharing in the last calendar year;
(3)the highest year-over-year increase in total spending before enrollee cost sharing;
(4)the highest year-over-year increase in total spending per user of any drug in the drug group before enrollee cost sharing;
(5)total enrollee cost sharing in the last calendar year; and
(6)the highest year-over-year increase in enrollee cost sharing per user of any drug in the drug group.
b. For each drug and drug group as defined by the division, the carrier shall report to the division the following minimum data, and other data that may be specified by the division, within 60 days of the close of each calendar year:
(1)total issuer spending before enrollee cost sharing in the last calendar year;
(2)margins and fees for each drug listed in subsection a. of this section paid directly to pharmacy benefits managers or pharmacy services administrative organizations in the last calendar year; and
(3)other retail discounts, price concessions, and fees for each drug listed in subsection a. of this section paid in the last calendar year.
L.2023, c.106, s.5.