Bill > S1192

This bill requires health insurance carriers to cover prescription drugs for serious mental illnesses without requiring prior authorization, which is a process to get approval before a service is provided, or other utilization management requirements, which are methods used to control healthcare costs. This includes eliminating "step therapy" protocols, also known as "fail-first" policies, where patients must try a less expensive drug before a more expensive one is covered, even if prescribed by a psychiatrist or an obstetrician/gynecologist during the postpartum period for individuals 18 and older. The bill also mandates that the Medicaid and NJ FamilyCare programs provide similar coverage for prescription drugs for serious mental illnesses, also without prior authorization or step therapy, under specific conditions related to the prescriber and the patient's treatment history. "Serious mental illness" is defined to include conditions like schizophrenia, bipolar disorders, and major depressive disorders, among others, consistent with the Diagnostic and Statistical Manual of Mental Disorders.

Budget and Finance, Business and Industry

https://www.njleg.state.nj.us/bill-search/2024/S1192