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A4005
ASSEMBLY, No. 4005
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED FEBRUARY 5, 2026
Sponsored by:
Assemblywoman� HEATHER SIMMONS
District 3 (Cumberland, Gloucester and Salem)
SYNOPSIS
���� Provides for procurement by State of pharmacy
benefits manager, automated reverse auction services, and claims adjudication
services.
CURRENT VERSION OF TEXT
���� As introduced.
��
An Act
providing for the procurement by the State of a
pharmacy benefits manager, automated reverse auction services, and claims
adjudication services.
����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:
���� 1.� a.� Notwithstanding the
provisions of any other law, rule, or regulation to the contrary, a contract
for the services of a pharmacy benefits manager for the State Health Benefits
Program and the School Employees� Health Benefits Program shall be procured in
an expedited process and in the manner provided by this section.
���� b.� The Division of Purchase
and Property in the Department of the Treasury shall procure, without the need
for formal advertisement, but through the solicitation of proposals from
professional services vendors, from qualified vendors the following three
services based upon price and other factors:
���� (1)�� technical assistance to
the State to evaluate the qualifications of bidders on a pharmacy benefits
manager procurement and to provide online automated reverse auction services to
support the Department of the Treasury in comparing the pricing for the pharmacy
benefits manager procurement.� The technology platform shall, if possible,
utilize a re-pricing of pharmacy benefits manager proposals for the State
Health Benefits Program and the School Employees� Health Benefits Program
pharmacy spending utilizing code-based classification of drugs from
nationally-accepted data sources of comparisons of the costs of pharmacy
benefits manager proposals;
���� (2)�� real-time, electronic,
line-by-line, claim-by-claim review of invoiced pharmacy benefits manager
pharmacy claims using an automated claims adjudication technology platform that
allows for online comparison of pharmacy benefits manager invoices and auditing
of other aspects of the services provided by the pharmacy benefits manager; and
���� (3)�� a pharmacy benefits
manager and related services.
���� c.� Notwithstanding the
provisions of any other law, rule, or regulation to the contrary, for the
purpose of expediting the procurements, the following provisions shall apply as
modifications to law or regulation that may interfere with the expedited award
of the above services:
���� (1)�� the timeframes for
challenging the specifications shall be modified as determined by the division;
���� (2)�� in lieu of advertising
in accordance with sections 2, 3, and 4 of P.L.1954, c. 48 (C.52:34-7,
C.52:34-8, and C.52:34-9), the division shall advertise the request for
proposals for the above services and any addenda thereto on the division�s
website;
���� (3)�� the period of time that
the State Comptroller has to review the request for proposals for these
professional services procurements for compliance with applicable public
contracting laws, rules and regulations, pursuant to section 10 of P.L.2007,
c.52 (C.52:15C-10), shall be 10 business days or less if practicable, as
determined by the State Comptroller;
���� (4)�� the timeframes for
submission under section 1 of P.L.1977, c.33 (C.52:25-24.2) and section 4 of
P.L.2012, c.25 (C.52:32-58) shall be extended to prior to the issuance of a
Notice of Intent to Award;
���� (5)�� the provisions of
section 1 of P.L. 2005, c.92 (C.52:34-13.2) shall not apply to technical and
support services, under this section, provided by a vendor using a �24/7
follow-the-sun model� as long as the contractor is able to provide such
services in the United States during the business day; and
���� (6)�� the term �bids� in
subparagraph (f) of subsection a. of section 7 of P.L.1954, c.48 (C.52:34-12)
shall not include pricing which will be revealed to all responsive bidders
during the negotiation process.
���� d.� The division may, to the
extent necessary, waive or modify any other law or regulation that may
interfere with the expeditious procurement of these services.
���� e.� Not later than 60 days
following the award of the pharmacy benefits manager contract for the State
Health Benefits Program and the School Employees� Health Benefits Program, the
division shall submit a report to the Governor, and to the Legislature pursuant
to section 2 of P.L.1991, c.164 (C.52:14-19.1), summarizing the results of the
reverse auction, the realized savings resulting from the procurement of the
services required under subsection b. of this section, the procedural
deviations taken by the division during the procurement process, and
information deemed necessary by the division to increase accountability and
oversight of the procurement process.� The division shall also make the report
available to the public by posting it on the division�s official website.
���� f.� �Reverse auction� means an
automated bidding process conducted online that starts with an opening price
and allows qualified bidders to counter offer a lower price, for as many rounds
of bidding as determined by the division.
���� 2.� This act shall take effect
immediately and shall expire after the award of the next pharmacy benefits
manager contract.
STATEMENT
���� This bill provides that the
State will procure, in an expedited manner, professional services contracts
for:
���� technical assistance to
evaluate the qualifications of bidders on a pharmacy benefits manager procurement
and online automated reverse auction services to support comparison of the
pricing for the pharmacy benefits manager procurement;
���� real-time, electronic,
line-by-line, claim-by-claim review of invoiced pharmacy benefits manager
pharmacy claims using an automated claims adjudication technology platform that
allows for online comparison of pharmacy benefits manager invoices and auditing
of other aspects of the services provided by the pharmacy benefits manager; and
���� a pharmacy benefits manager
for the State Health Benefits Program (SHBP) and the School Employees� Health
Benefits Program (SEHBP).
���� The bill authorizes the
Division of Purchase and Property in the Department of the Treasury, to the
extent necessary, to waive or modify any other law or regulation that may
interfere with the procurement of these services.
���� Following the award of the
pharmacy benefits manager contract, the bill requires the division to publish a
report summarizing the results of the reverse auction, the realized savings
resulting from the procurement of the required services required, any
procedural deviations taken by the division during the procurement process, and
any information deemed necessary by the division to increase accountability and
oversight within 60 days.��
���� The bill will take effect
immediately and expire after the next pharmacy benefits manager contract is awarded.
���� In 2016, a similar law was
enacted under P.L.2016, c.67, which required the division to hire a claims
adjudication auditing firm and adopt a reverse auction process for the purposes
of contracting with a pharmacy benefits manager for the SHBP or the SEHBP.� As
a result, the Department of the Treasury reported an estimated $40 million in
savings for the SHBP in Fiscal Year 2017.