Bill > S1125

Introduced Session

This bill requires hospital, medical, and health service corporations, commercial individual and group health insurers, health maintenance organizations, and health benefits plans issued pursuant to the New Jersey Individual Coverage and Small Employer Health Benefits Programs, as well as the State Health Benefits Commission and the School Employees' Health Benefits Commission, to provide health benefits coverage for expenses for prescribed combination antiretroviral drug treatments that are medically necessary for the treatment of AIDS or HIV. The bill further specifies that coverage for this treatment shall be required as follows: (1) Coverage shall be required for a single tablet drug regimen in situations in which that regimen is as effective as a multitablet regimen. (2) In situations in which the multitablet regimen, consistent with clinical guidelines and peer-reviewed scientific and medical literature, is clinically equally to, or more effective than, the single tablet drug regimen, and more likely to result in patient adherence, coverage shall be required for the multitablet regimen, provided the peer review of the literature has been performed by a health care provider with experience in treating infectious diseases. The bill requires insurers that use a prior authorization process to assess medical necessity with respect to the coverage required by this bill to complete that process within 14 days of the request for authorization. If the prior authorization process is not completed in that time period, the request for authorization shall be deemed to be approved.

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Joe Vitale (D)*, 

Introduced in the Senate, Referred to Senate Commerce Committee (on 01/31/2022)

Official Document