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Bill > A4425


NJ A4425

NJ A4425
Prohibits SHBP, SEHBP, and Medicaid from denying coverage for maintenance medications for chronic conditions for covered persons solely because of change in health benefits plan or pharmacy benefits manager.


summary

Introduced
06/29/2022
In Committee
06/29/2022
Crossed Over
Passed
Dead
01/08/2024

Introduced Session

2022-2023 Regular Session

Bill Summary

This bill would prohibit contracts which are issued or purchased pursuant to the State Health Benefits Program, School Employees' Health Benefits Program, and Medicaid Program from denying coverage for a maintenance medication prescribed by a covered person's physician for the covered person's chronic condition because of a change in the covered person's pharmaceutical benefits that results solely from a change in the health benefits plan or the pharmacy benefits manager for that plan. The prohibition applies only if the covered person was taking the medication prior to the date of the change in the covered person's health benefits plan or the pharmacy benefits manager for that plan, and if the covered person's new health benefits plan, or health benefits plan under the new pharmacy benefits manager, as applicable, provides coverage for that class of drugs.

AI Summary

This bill prohibits the State Health Benefits Program (SHBP), the School Employees' Health Benefits Program (SEHBP), and Medicaid from denying coverage for maintenance medications for chronic conditions for covered persons solely because of a change in their health benefits plan or pharmacy benefits manager. The prohibition applies only if the covered person was taking the medication prior to the change and the new plan or pharmacy benefits manager provides coverage for that class of drugs.

Committee Categories

Business and Industry

Sponsors (2)

Last Action

Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 06/29/2022)

bill text


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