New Jersey Senate Bill S1076

New Jersey 2022-2023 Regular Session

• Introduced: 1/31/22
• Refer: 1/31/22

Caption

Requires all Medicaid managed care organization to permit all pharmacies in State to dispense prescriptions for all covered medications.

Impact

The legislation requires that no pharmacy can be excluded from the Medicaid network under arbitrary criteria, thus promoting fair competition among pharmacies. It also prohibits Medicaid managed care organizations from imposing unequal costs or fees on enrollees based on their pharmacy choice, thereby fostering an equitable environment for all healthcare providers and their patients. This is anticipated to lead to improved access and reduced out-of-pocket costs for enrollees when obtaining their prescriptions.

Summary

Senate Bill S1076 aims to enhance options for enrollees in New Jersey's Medicaid managed care programs by mandating that all Medicaid managed care organizations allow any pharmacy in the state to dispense prescriptions for covered medications. The bill directly addresses the barriers that pharmacies may face in participating in the Medicaid network, stipulating that all pharmacies willing to accept the terms of the Medicaid managed care contracts can do so. This is expected to ensure better access to medications for enrollees by widening the range of pharmacies they can choose from.

Contention

While the bill seeks to provide more flexibility and options for Medicaid enrollees, there may be concerns regarding the financial implications for Medicaid managed care organizations and the overall impact on the healthcare market. Notably, stakeholders may debate whether allowing unrestricted pharmacy access would lead to balanced utilization of pharmacies and sustainability within the Medicaid program. Opponents might argue that it could potentially strain resources if pharmacies are unable to cope with increased demands without adequate reimbursement structures.