What New Jersey's State Health Benefits Program pays for its top drugs

In plan year 2025, the three groups the State Health Benefits Commission and the School Employees' commission oversee spent $4.16 billion on prescription drugs before anything came back. Manufacturer rebates returned $1.43 billion (34%). Medicare Part D payments and discounts for the retiree drug plans (the EGWP credits) returned another $0.91 billion. The net was $1.82 billion. In all, 56% of the gross came back.

Source: Aon, Plan Year 2027 Rate Setting Recommendations, Exhibit 3A, "Total" column, for each group. The rebate line also includes drug rebates paid through the Horizon medical plans.

So the gross figures below overstate what the state finally pays. They are still the right place to look for one reason: the rebate is a percentage of a price someone else sets. When the gross price of a drug is high, the plan pays it first and waits for part of it to come back.

Stelara (ustekinumab) treats psoriasis, Crohn's disease and ulcerative colitis, and its biosimilars reached the market in 2025. On July 1, 2025, Optum Rx removed Stelara from its Premium formularies in favor of Wezlana. Optum sells that Wezlana through Nuvaila, an Optum company, in a high list price version and a low list price version (Drug Channels, July 2025). By the first half of 2026, Wezlana was on the plan's top-ten list.

The switch moved patients. It moved the cost per prescription much less.

Sources: Optum Rx, SHBP Pharmacy Trend Update, May 13, 2026 (slide 6) and September 9, 2026 (slide 7). Cost Plus price from the Verzi Health API capture of costplusdrugs.com, unchanged since September 11, 2026 and checked October 21, 2026; $360 before shipping, for either the 45 mg or the 90 mg syringe.

Is a prescription one dose? Close to it. Wezlana's 569 prescriptions went to 179 members in six months, about one every eight weeks. That is the maintenance schedule for Crohn's disease and ulcerative colitis: one 90 mg injection every eight weeks. For psoriasis it is every 12 weeks. So for most of these members, one prescription is close to one dose.

What rebates change. The $23,184 is before rebates, and Optum does not report a rebate for Wezlana alone. The published reports give no rebate for its drug class either. The public documents do not say which Wezlana version the plan pays for, or its rebate. The working group can ask for the net cost of one Wezlana prescription and set it beside $360.

Adalimumab went first. In 2024 the plan paid for 4,980 Humira Pen prescriptions. In 2025 it paid for 1,821 Humira Pen prescriptions and 2,891 prescriptions of Amjevita, an adalimumab biosimilar. The decks list the pen form of Humira as its own line.

The decks do not give the days of supply per prescription, and adalimumab prescriptions are often filled for more than 28 days. So the per-prescription figures here are not per month, and this table does not compare them with the Cost Plus kit directly. What it does show: Amjevita's cost per prescription rose from $7,839 in 2025 to $8,594 in the first half of 2026, before rebates.

Optum Rx manages the plan's pharmacy benefit now. The bid solicitation for the next contract (NJSTART 27DPP01337) covers January 1, 2028 to December 31, 2031. The state and the contractor can extend it by up to two years, one year at a time. Qualified bidders compete in a reverse auction. Bids are due November 17, 2026 at 2 p.m. Eastern (Bid Amendment 6, October 22, 2026).

It is a pass-through contract at the retail counter, and it passes rebates through:

The definition of pass-through pricing names where the contractor may still earn a margin:

Biologics such as Stelara, Wezlana, Humira and Amjevita are typically handled as specialty drugs. The solicitation defines the Specialty Drug Pharmacy as the pharmacies "the Contractor uses" (Section 9.3). Section 4.9.2 says: "Invoice each Specialty Drug Claim dispensed from the Specialty Drug Pharmacy using the Specialty Drug Minimum Guaranteed Discounts." All specialty claims must also meet the Specialty Drug Overall Effective Discount. Section 9.3 defines it as an Ingredient Cost Discount: the percentage difference from the average wholesale price (AWP), a list-based benchmark. So a specialty price is a guaranteed discount off a list price, and it follows the list price. The contractor must meet the discount on every claim and pay back any shortfall.

Biosimilars are priced "at prevailing market rates" (Section 4.9.2), a term the solicitation does not define. The same section adds: "The Contractor shall ensure the State receives Most Favored Nation (MFN) pricing for any Biosimilar Drug that is approved by the FDA during the term of this Contract." That clause covers biosimilars approved after the contract starts, not the ones on the market now, such as Wezlana and Amjevita.

The solicitation also gives the state a way out of that channel. Among the specialty protocols the state may set:

Read together: the retail counter is pass-through, and the rebates are passed through. The contractor earns administrative fees. Beyond those, the contract allows it a margin in two places: mail order, and the specialty pharmacy, within the discount guarantees. The specialty pharmacy is where the most expensive drugs on this page are filled. The solicitation lets the state name a different pharmacy to fill specific specialty drugs while the contractor processes the claim.

The biggest lines in the plan are the GLP-1 drugs. In 2025, Wegovy and Zepbound alone cost the plan $297.9 million before rebates, and Zepbound's spend rose from $32.7 million to $146.3 million in one year. These are gross figures, before rebates, and the published reports give no rebate for these drugs. Cost Plus does not sell them. Wegovy also has a fixed cash price: $349 a month on TrumpRx for doses from 0.25 mg to 2.4 mg. The open question in this plan is the specialty biologics, where the cash alternative costs a few hundred dollars.

SHBP commercial (State and Local, actives and early retirees), as Optum reports them to the plan. Plan paid is before rebates and after member cost share.

• Aggregate costs: Aon, Plan Year 2027 Rate Setting Recommendations for the SHBP State group, the SHBP Local group and the SEHBP, approved September 2026, Exhibit 3A (plan year 2025, "Total" column). State · Local · Education.
• Drugs: Optum Rx, SHBP Pharmacy Trend Update, May 13, 2026 (2025 against 2024) and September 9, 2026 (first half of 2026 against first half of 2025). "Per prescription" is plan paid divided by prescriptions, computed here.
• Contract: NJSTART bid 27DPP01337 (T2679), Bid Solicitation of August 6, 2026, with Bid Amendment 4 moving the bid opening to October 30, 2026, and Bid Amendment 6 moving it to November 17, 2026.
• Cost Plus Drugs prices: the public price list at costplusdrugs.com, captured as dated, change-only snapshots by the Verzi Health data API. Prices exclude shipping.
• The build parses every figure from the documents and checks each against a hand-typed copy, then checks that this page states each figure it produces. Any mismatch stops the build.

What this can and cannot say. The documents give gross costs by drug and rebates only in total and by drug class, so this page does not state a net cost for any single drug. Plan paid excludes the member's copay. Prescriptions are not doses or months, except where the page shows that they line up. The SEHBP has its own pharmacy reports, not used for the drug tables here. Nothing here describes the quality of any drug or the conduct of any company.