# N.J. Stat. § 17B:27F-3.4: Carrier, use of pharmacy benefits manager, administer, manage, prescription drug benefits, claims, parameters

> New Jersey · Statutes · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_NJ_T17B_C27F_S27F-3.4

## Section

- **Citation:** N.J. Stat. § 17B:27F-3.4
- **Heading:** Carrier, use of pharmacy benefits manager, administer, manage, prescription drug benefits, claims, parameters
- **Jurisdiction:** New Jersey
- **Kind:** Statutes
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** NJ Code / Title 17B / Chapter 27F / Section 27F-3.4

## Text

9. a. If a carrier uses a pharmacy benefits manager to administer or manage the prescription drug benefits of covered persons, any pharmacy benefits manager compensation, for purposes of calculating a carrier's anticipated loss ratio or any loss ratio calculated as part of any applicable medical loss ratio filing or rate filing, shall: (1) constitute an administrative cost incurred by the carrier in connection with a health benefits plan; and (2) not constitute a benefit provided under a health benefits plan. A carrier shall claim only the amounts paid by the pharmacy benefits manager to a pharmacy or pharmacist as an incurred claim. b. Any rate filing submitted by a carrier with respect to a health benefits plan that provides coverage for prescription drugs or pharmacy services and that is administered or managed by a pharmacy benefits manager shall include: (1) a memorandum prepared by a qualified actuary describing the calculation of the pharmacy benefits manager compensation; and (2) any records and supporting information as the department reasonably determines is necessary to confirm the calculation of the pharmacy benefits manager compensation. c. Upon request, a carrier shall provide any records to the department that relate to the calculation of the pharmacy benefits manager and pharmacy services administrative organization compensation. d. A pharmacy benefits manager and pharmacy services administrative organization shall provide any necessary documentation requested by a carrier that relates to pharmacy benefits manager compensation in order to comply with the requirements of this section. L.2023, c.107, s.9.

## Nearby sections

- [N.J. Stat. § 17B:27F-1 Definitions.](https://www.frixlaw.com/law-library/statutes/STATE_NJ_T17B_C27F_S27F-1.md)
- [N.J. Stat. § 17B:27F-1.1 Pharmacy benefits manager, license, pharmacy services administrative, registration.](https://www.frixlaw.com/law-library/statutes/STATE_NJ_T17B_C27F_S27F-1.1.md)
- [N.J. Stat. § 17B:27F-2 Duties, pharmacy benefits manager, contracts.](https://www.frixlaw.com/law-library/statutes/STATE_NJ_T17B_C27F_S27F-2.md)
- [N.J. Stat. § 17B:27F-3 Carrier, pharmacy benefits manager under contract, single maximum allowable cost list; prescription drug, source generic list, requirements.](https://www.frixlaw.com/law-library/statutes/STATE_NJ_T17B_C27F_S27F-3.md)
- [N.J. Stat. § 17B:27F-3.1 Carrier duties, responsibilities.](https://www.frixlaw.com/law-library/statutes/STATE_NJ_T17B_C27F_S27F-3.1.md)
- [N.J. Stat. § 17B:27F-3.2 Compensation remitted, pharmaceutical manufacturer, developer, labeler, carrier, pharmacy benefits manager under contract; report.](https://www.frixlaw.com/law-library/statutes/STATE_NJ_T17B_C27F_S27F-3.2.md)
- [N.J. Stat. § 17B:27F-3.3 Carrier, pharmacy benefits manager under contract, pharmacy and therapeutics committee, established, formulary system management.](https://www.frixlaw.com/law-library/statutes/STATE_NJ_T17B_C27F_S27F-3.3.md)
- [N.J. Stat. § 17B:27F-3.4 Carrier, use of pharmacy benefits manager, administer, manage, prescription drug benefits, claims, parameters.](https://www.frixlaw.com/law-library/statutes/STATE_NJ_T17B_C27F_S27F-3.4.md)
- [N.J. Stat. § 17B:27F-4 Process for appeals, investigation and dispute.](https://www.frixlaw.com/law-library/statutes/STATE_NJ_T17B_C27F_S27F-4.md)
- [N.J. Stat. § 17B:27F-5 Rules, regulations.](https://www.frixlaw.com/law-library/statutes/STATE_NJ_T17B_C27F_S27F-5.md)
- [N.J. Stat. § 17B:27F-6 Regulations, pharmacy benefits managers.](https://www.frixlaw.com/law-library/statutes/STATE_NJ_T17B_C27F_S27F-6.md)
- [N.J. Stat. § 17B:27F-6.1 Requirements for pharmacy benefits managers.](https://www.frixlaw.com/law-library/statutes/STATE_NJ_T17B_C27F_S27F-6.1.md)
- [N.J. Stat. § 17B:27F-7 "Clean Claim" made by a pharmacy, actions of pharmaceutical benefits managers.](https://www.frixlaw.com/law-library/statutes/STATE_NJ_T17B_C27F_S27F-7.md)
- [N.J. Stat. § 17B:27F-8 Commissioner review, approval.](https://www.frixlaw.com/law-library/statutes/STATE_NJ_T17B_C27F_S27F-8.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_NJ_T17B_C27F_S27F-3.4. Check the current official text before relying on it. Not legal advice.