Senator Vin Gopal Announces Joint Statement from District 11 Legislators, Senate President Scutari, Speaker Coughlin, Senate Health Committee Chair Vitale, Assembly Health Committee Chair Conaway and longtime Senate PBM Transparency Advocates Senators Greenstein, Mukherji and Singleton.

Trenton, NJ – In the light of recent findings from a New York Times investigation on Pharmacy Benefit Managers (PBMs), a group of New Jersey lawmakers and independent pharmacists are coming together to address the impact of PBMs and the crisis of rising drug costs on New Jersey. Senator Vin Gopal, Assemblywoman Margie Donlon, M.D., and Assemblywoman Luanne Peterpaul join Senate President Scutari, Assembly Speaker Craig Coughlin, Senate Health Chairman Joseph Vitale, Senators Raj Mukherji, Troy Singleton, Linda Greenstein, and Assembly Health Chairman Herb Conaway, M.D., in affirming their commitment to affordable prescription costs and regulating PBMs.

“We are proud to convene members of State Senate and Assembly leadership to take a comprehensive look at the status of PBMs and how they impact consumers, employers, and independent pharmacists. The role of PBMs is to be an intermediary between pharmacists, employers, and insurers to ensure the most cost-effective medication routes. If state health benefits programs and Medicaid are being taken advantage of by PBMs or given increasingly high premiums, as alleged by the New York Times investigation, those costs are footed by taxpayers for private gain. There is an urgent need to address the impact of PBMs on the current market. We are committed to working together in the legislature to protect the well-being of consumers, employers, and independent pharmacists,” stated the LD11 team of Senator Gopal, Assemblywoman Donlon, and Assemblywoman Peterpaul (Monmouth).

“Regulating PBMs and their impact is an important initiative of the New Jersey Legislature. Last year, we passed important legislation to make prescription medications more affordable, including provisions that tighten rules for PBMs. This legislation, signed into law in July 2023, includes greater transparency, disclosure of lower-cost options, prohibitions on overcharging, stronger regulations for contracts between PBMs and pharmacies, penalties for violating licensing requirements, and stronger reporting requirements,” said Senate President Nick Scutari (Somerset, Union). “These are consumer protections that will help make medicines more affordable and more accessible for those in need.”

“We have made progress expanding access to affordable prescription drugs for New Jersey seniors and families, but PBMs have proven to be a substantial obstacle to fair prices,” said Assembly Speaker Craig J. Coughlin (Middlesex). “I join Sen. Gopal and other colleagues in the call for an investigation into potential market manipulation. While PBMs are pocketing billions in profits, patients are hit with inflated prices and unreliable coverage as well as outright abuse of the pharmacy community. Since my days as chair of the Assembly Financial Institutions and Insurance Committee, we have enacted numerous state laws to equip the Department of Banking and Insurance with the tools to properly monitor and regulate these behemoths. It’s time we explore further avenues for accountability.”

Senators Gopal, Scutari, Vitale, Singleton, and Greenstein were integral to passing historic legislation regarding PBMs last year. The group of lawmakers is hopeful that the laws have a positive impact on the community when they go into effect in January 2025.

“As legislators, it is our responsibility to prevent and protect New Jersey residents from malfeasance like that alleged by the New York Times. It is important to regularly review existing arrangements to ensure patient needs are being put first and that business profits are not impeding patients from affording life-saving medications,” stated Senate Health, Human Services and Senior Citizens Committee Chairman Vitale (Middlesex). “While I have worked hard alongside many of my colleagues to improve access to affordable medication, more transparency and accountability of the system is needed.

“Our primary focus is to ensure all New Jersey residents have access to essential health care services and that the fiscal health of our state is not threatened by PBM’s. PBM’s need to be heavily regulated by the New Jersey Department of Banking and Insurance. They need to be held to a fiduciary standard that protects our citizens. We have seen significant increases in the cost of our employee State Health Benefits plans, with the price of drugs being a key factor,” stated Senator Greenstein (Mercer, Middlesex).

“Patients, physicians, pharmacists, insurers, and premium payers alike are being harmed by PBMs’ exploitative actions, and our past actions to bring equilibrium apparently aren’t enough,” said Senator Raj Mukherji (Hudson). “Our independent pharmacies are facing unsustainable financial pressures and existential threats to survival, owing largely to unconscionable practices by PBMs. We will continue prioritizing drug affordability and monitoring the well-being of our independent pharmacies to ensure that New Jerseyans are not taken advantage of by PBMs.”

“Prescription benefit management companies play a crucial role in the healthcare system, yet their operations often lack the transparency needed to ensure fair pricing for consumers,” said Senator Troy Singleton (Burlington), who has championed prescription drug reforms during his time in the Legislature. “Recent reports further demonstrate that more accountability and oversight is needed.  We will continue our efforts to make prescription drugs more affordable for everyone who needs them. No one should jeopardize their health, or cut doses, because they cannot afford their medicine.”

“Prescriptions are taken to alleviate pain, not create more. The last thing patients need is to miss out on life-saving drugs due to arbitrary, and often restrictive, PBM-designed formularies. As a physician, I understand the need to expand prescription drug access for patients. Exorbitant markups by PBMs can prevent or delay patients from receiving their prescriptions, allowing for potential adverse health outcomes,” stated Assembly Health Chairman Herb Conaway (Burlington).

“Community-level medication access in NJ is at a critical crossroads. While chain pharmacies continue to announce significant closures, the US has lost nearly 12% of its independent pharmacies since 2020. NJ’s patients and providers have suffered the consequences of an opaque PBM model, wrought with warped incentives, for long enough. PBMs utilize prior authorizations to delay therapy, mail order and specialty pharmacy to steer or limit access, and pricing manipulation to choke community pharmacies while overcharging plan sponsors. NJ’s patients deserve transparency and accountability in the taxpayer-funded benefit programs we rely on for access to critical medications,” stated Pharmacist Brian Oliveira, Executive Director of Garden State Pharmacy Owners.

Elise Barry, CEO of the New Jersey Pharmacists Association added, “community pharmacies and their patients are facing significant challenges due to PBM practices over which they and their pharmacies have no control. As the evidence presented in various recent articles and news stories in the largest newspapers in the country continues to mount, Americans are increasingly disadvantaged at the pharmacy counter and so are the plan sponsors who pay the bill for their care. Achieving the best possible outcomes in healthcare is about people. The ability to receive pharmacists’ care in their own neighborhood is essential to maintaining good health. It is essential that equitable drug pricing and reimbursement is established in the marketplace.”

“The articles from the New York Times and Wall Street Journal serve as crucial wake-up calls to curb the anti-competitive practices of pharmacy benefit managers (PBMs). The PBM business model is designed to artificially inflate drug prices and extract billions of dollars in discounts from drug manufacturers. Unfortunately, most patients never see these discounts and end up paying higher prices at the pharmacy counter. Additionally, PBMs extract billions of dollars from pharmacies in the form of fees, these discounts rarely benefit patients and create economic uncertainty for independent pharmacies. Patients, pharmacies, and taxpayers are bearing the brunt of the PBM industry’s pursuit of profits. It is essential that we enact and enforce reforms to combat these anti-competitive and anti-patient behaviors,” stated Anthony Reznik, Director of Government Affairs for Independent Pharmacy Alliance.

Senators Gopal, Scutari, Vitale, Greenstein, Mukherji, and Singleton, as well as Assemblypeople Coughlin, Donlon, Peterpaul, and Conaway, are committed to working alongside independent pharmacy stakeholders to provide increased oversight on PBMs.

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Senator Vin Gopal, a lifelong resident of Monmouth County elected in 2018, serves as Senate Majority Conference Leader and Chair of the Senate Education Committee. Assemblywoman Dr. Margie Donlon, a practicing physician, serves on the Assembly Health and the Tourism, Gaming & the Arts Committees; Assemblywoman Luanne Peterpaul, Esq., serves on the Assembly Commerce, Economic Development & Agriculture, and the Aging & Human Services Committees. They represent residents of Allenhurst, Asbury Park, Bradley Beach, Colts Neck, Deal, Eatontown, Fair Haven, Freehold Borough, Freehold Township, Interlaken, Loch Arbour, Long Branch, Neptune City, Neptune Township, Ocean Township, Red Bank, Shrewsbury Borough, Shrewsbury Township, and Tinton Falls in the State Senate and State Assembly.