T2679 - Employee Benefits : Pharmacy Benefits Management

2026-11-03

SCOPE OF WORK NETWORK ACCESS / PHARMACY DISTRIBUTION CHANNELS RETAIL PHARMACY NETWORK The Contractor is to perform the below requirements . The Contractor shall : Establish and maintain a network of Participating Pharmacies that have agreed to discount their charges for prescription drugs ; Ensure that its PBM / Participating Pharmacy contracts satisfy all State and federal licensure , record - keeping , access and consumer protection requirements ; Ensure that a minimum of 98 . 0 % of all Members have an available Retail Pharmacy in the Pharmacy Network within the following radius of their residence : Urban : within 1 . 5 miles ; Suburban : within 3 miles ; and Rural : within 10 miles ; Provide advance written notification to the SCM of any change in the Pharmacy Network that will affect a 1 . 0 % or greater change in the number of Participating Pharmacies in the Pharmacy Network or a disruption that would impact 3 . 0 % or greater of the Members in the SHBP / SEHBP . The Contractor shall ensure the written notice of change is provided to the SCM at least 45 Calendar Days prior to the change . The Contractor must provide the SCM , at the same time , with a list of the names of the Members that will be affected by the discontinuation ; Provide a detailed written notification to the impacted Members of such network change as described in part D above . This shall be provided to the impacted Members at least 30 Calendar Days prior to the change . Notification to the Member shall include , but need not be limited to : Name of impacted pharmacy ; Name of alternate pharmacy ; Distance to alternate pharmacy ; Address of alternate pharmacy ; Phone number of alternate pharmacy ; and Directions on how to move prescriptions to alternate pharmacy . Provide the State with improved discount guarantees for the retail 30 brand and retail 30 generic pricing guarantees , and reporting , if the number of Participating Pharmacies in the Pharmacy Network is reduced by more than 3 . 0 % before the effective date or any point during the term of the Contract . This offer shall be provided to SCM at least 90 Calendar Days prior to the effective date of the change . The reduction in network size must be approved in writing by the SCM ; and Ensure that Retail Pharmacy Claims are paid within 30 Calendar Days of receipt by the PBM . RETAIL PHARMACY 90 - DAY NETWORK The Contract shall perform the below requirements in relation to the Retail Pharmacy 90 - day Network . The Contractor shall : Have a network of pharmacies to dispense 90 - day supplies of maintenance medications ; Maintain a network of pharmacies that have agreed to discount their charges for 90 - day supplies of prescription drugs ; Ensure that the 90 - day Retail Pharmacy contracts satisfy all State and federal licensure , record - keeping , access and consumer protection requirements ; Ensure that a minimum of 98 . 0 % of all Members have an available Retail Pharmacy in the Pharmacy Network within a ten ( 10 ) mile radius of their residence ; Provide advance written notification to the State of any change in the Retail Pharmacy 90 - Day Network that will affect a 1 . 0 % or greater change in the number of Participating Pharmacies in the Retail Pharmacy 90 - Day Network or a disruption that would impact 3 . 0 % or greater of the Members in the SHBP / SEHBP . The Contactor shall ensure the written notice of change is provided to the SCM at least 45 Calendar Days prior to the change . The Contractor must provide the State , at the same time , with a list of the names of the Members that will be affected by the discontinuation ; Provide a detailed written notification to the impacted Members of such network change . This shall be provided to the impacted Members at least 30 Calendar Days prior to the change . Notification to the Member shall include but need not be limited to : Name of impacted pharmacy ; Name of alternate pharmacy ; Distance to alternate pharmacy ; Address of alternate pharmacy ; Phone number of alternate pharmacy ; and Directions on how to move prescriptions to alternate pharmacy ; and Provide the State with improved discount guarantees for the retail 90 brand and retail 90 generic pricing guarantees if the number of Participating Pharmacies in the Retail Pharmacy 90 - Day Network is reduced by more than 3 . 0 % before the effective date or any point during the term of the Contract . This offer shall be provided at least 90 Calendar Days prior to the effective date of the change . The reduction in network size must be approved in writing by the SCM ; and Ensure that Retail 90 day Pharmacy Claims are paid within 30 Calendar Days of receipt by the PBM . MAIL ORDER PHARMACY The Contractor shall , in conjunction with the Mail Order Pharmacy : Ensure at least 95 . 0 % of all Non - Protocol Prescriptions are dispensed within two ( 2 ) Business Days following receipt of the prescription by the Contractor ;

New Jersey

2026-04-29