At the regularly scheduled August meeting of the State Health Benefits Plan (SHBP) Plan Design Committee, it adopted six resolutions for Plan Year 2026. The resolutions, which are not currently publicly available on the Treasury’s website, include:
- RESOLUTION 2025-3 Reduced Specialty Copay
- RESOLUTION 2025-4 Formulary Management and Out-of-Network Physical Therapy
- RESOLUTION 2025-5 Mail Order Incentive and $0 Copay for Generic Mail Order Prescription Drugs
- RESOLUTION 2025-6 Generic Substitution Preference
- RESOLUTION 2025-7 Copay Reduction for Retiree Mail Order Preferred Brand Prescription Drugs
- RESOLUTION 2025-8 Tiered Network Plan Financial Incentive Pilot Program
There was significant discussion of Resolution 2025-4 Formulary Management and Out of Network Physical Therapy. Members representing labor believe that the State needs to negotiate better savings and that Optum should work with pharmacy benefits managers (PBMs) to ensure larger savings for the plan. It was asked what would occur if this resolution were to fail, and it was stated that there would be an increase of $93 million to the cost of Plan Year 2026 because more prescription types would be available, costing more, and affecting the negotiated rebates. This measure ultimately passed 11-1.
There was no discussion of the other 5 resolutions, which were grouped together and passed 12-0 without any discussion.
There was no discussion of the AON analysis of the management and labor proposals to achieve the needed $100 million in plan savings in the first six months of 2026.
As we have previously reported, the recommended increase for SHBP Local Government is 36.5%. The State Health Benefits Commission is scheduled to meet next Wednesday, September 3, to set the rates for Plan Year 2026. It is not clear whether there will be changes to the proposed increase prior to this meeting.
As a reminder, the Plan Design committee has until September 30 to meet and vote on each proposal that AON determines will result in recurring and actuarially verifiable cost savings. If the Plan Design Committee is unable to reach an agreement, they immediately begin mediation.
We will continue to report as details warrant.
Contact: Paul Penna, Director of Government Affairs, ppenna@njlm.org, 609-695-3481, x110.