NJ S2345

Establishes a fiduciary duty for pharmacy benefits managers (PBMs) to prioritize the long-term health outcomes of covered persons and prohibits misleading marketing to steer patients toward specific pharmacies.

Requires PBM compensation to be structured as flat fees only, eliminating commission-based payment arrangements.

Invalidates agreements between PBMs and drug manufacturers that condition rebates on excluding generic drugs from coverage.

Mandates PBMs reimburse contracted and network pharmacies at least at the pharmacy's drug acquisition cost, with independent pharmacies reimbursed at no more than 5% below network rates but never below acquisition cost.

Requires pharmacy and therapeutics committees to ensure formulary decisions do not favor higher-cost drugs over lower-cost generics or biosimilars, and presumes PBM-pharmacy contracts are "contracts of adhesion" subject to judicial scrutiny in disputes.