NJ A5217

Requires health insurance carriers, third-party administrators, and pharmacy benefits managers to count all cost-sharing payments made by or on behalf of an enrollee toward deductibles, copayments, coinsurance, and out-of-pocket maximums, including payments from manufacturer coupons or patient assistance programs

Prohibits carriers and pharmacy benefits managers from altering health plan coverage terms or benefit designs based on the availability or amount of third-party financial assistance for prescription drugs

Applies federal Affordable Care Act annual out-of-pocket limits to all covered health care services under New Jersey health benefits plans

Requires carriers, third-party administrators, and pharmacy benefits managers to submit annual compliance certifications to the Commissioner of Banking and Insurance by March 31 each year

Takes effect 90 days after enactment and applies to health plans delivered, issued, executed, or renewed on or after that date; excludes Medicare supplement, Medicaid, TRICARE supplement, workers' compensation, and self-insured ERISA plans