New Jersey legislation · 2026-2027 Regular Session
New Jersey S4692: Pharmacy benefits managers-estab standards for timely payment of clean claims
Status: In committee, October 1, 2026
Establishes standards for timely payment of clean claims by pharmacy benefits managers.
What the bill says
An Act concerning pharmacy benefits managers and amending P.L.2019, c.274.
From the introduced text, October 1, 2026:
An Act concerning pharmacy benefits managers and amending P.L.2019, c.274. Be It Enacted by the Senate and General Assembly of the State of New Jersey: 1. Section 1 of P.L.2019, c.274 (C.17B:27F-7) is amended to read as follows: 1. a. After the date of receipt of a clean claim for payment made by a pharmacy, a pharmacy benefits manager shall not retroactively reduce payment on the claim, either directly or indirectly, through aggregated effective rate, direct or indirect remuneration, quality assurance program, or otherwise, except if the claim is found not to be a clean claim during the course of a routine audit performed pursuant to an agreement between the pharmacy benefits manager and the pharmacy. When a pharmacy adjudicates a claim at the point of sale, the reimbursement amount provided to the pharmacy by the pharmacy benefits manager shall constitute a final reimbursement amount. Nothing in this section shall be construed to prohibit any retroactive increase in payment to a pharmacy pursuant to a contract between the pharmacy benefits manager, and the pharmacy services administration organization, or a pharmacy. b. For the purpose of this section, "clean claim" means a claim that has no defect or impropriety, including a lack of any required substantiating documentation, or other circumstance requiring special treatment, including, but not limited to, those listed in …
Sponsors
- Douglas J. Steinhardt (R, 23) · primary sponsor
- Vin Gopal (D, 11) · primary sponsor
- Angela V. McKnight (D, 31)
Latest actions
- : INT 1RS REF SCM
Subjects: HEALTH - PHARMACEUTICALS
Common questions
- What is S4692?
- S4692 is a bill in the New Jersey Legislature (2026-2027 Regular Session): Pharmacy benefits managers-estab standards for timely payment of clean claims.
- What does S4692 do?
- In its own words: An Act concerning pharmacy benefits managers and amending P.L.2019, c.274.
- What is the status of S4692?
- In committee as of October 1, 2026. Latest action: INT 1RS REF SCM (October 1, 2026).
- Who sponsored S4692?
- Douglas J. Steinhardt (R, 23), with 2 co-sponsors.
- Where is the official record for S4692?
- On the New Jersey Legislature website: https://www.njleg.state.nj.us/bill-search/2026/S4692
Source: official New Jersey record. Tracked by Delilah, AI for legislation across all 50 states and Congress.