New Jersey legislation · 2026-2027 Regular Session
New Jersey A5633: Pharmacy benefits managers-estab standards for timely payment of clean claims
Status: In committee, October 15, 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 15, 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
- Roy Freiman (D, 16) · primary sponsor
- Al Barlas (R, 40) · primary sponsor
Latest actions
- : INT 1RA REF AFI
Subjects: HEALTH - PHARMACEUTICALS
Common questions
- What is A5633?
- A5633 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 A5633 do?
- In its own words: An Act concerning pharmacy benefits managers and amending P.L.2019, c.274.
- What is the status of A5633?
- In committee as of October 15, 2026. Latest action: INT 1RA REF AFI (October 15, 2026).
- Who sponsored A5633?
- Roy Freiman (D, 16), with 1 co-sponsor.
- Where is the official record for A5633?
- On the New Jersey Legislature website: https://www.njleg.state.nj.us/bill-search/2026/A5633
Source: official New Jersey record. Tracked by Delilah, AI for legislation across all 50 states and Congress.