Bill > A1825

This bill establishes comprehensive guidelines for step therapy protocols in New Jersey's State Health Benefits Program (SHBP), School Employees Health Benefits Program (SEHBP), and Medicaid, aiming to protect patients from potentially harmful or ineffective prescription drug sequences. The legislation requires that step therapy protocols be based on scientifically rigorous clinical practice guidelines developed by multidisciplinary expert panels, with strict requirements for managing conflicts of interest and ensuring objectivity. Health care providers and patients will have a clear, accessible process to request exceptions to step therapy protocols when the required medications could cause adverse reactions, be ineffective, or are inappropriate for a specific patient's medical condition. Managed care organizations and vendors must provide a transparent exception request process, with decisions to be made within 24 hours for urgent requests and 72 hours for non-urgent requests. The bill mandates that these organizations make their clinical review criteria publicly available, consider the needs of atypical patient populations, and publish statistics about step therapy exception request approvals and denials. Importantly, the legislation preserves healthcare providers' ability to prescribe medications they determine to be medically appropriate and does not prevent the use of generic equivalents or biosimilar products. The bill will take effect on January 1, 2026, applying to all new and renewed insurance contracts and policies.

Budget and Finance, Business and Industry, Health and Social Services

https://www.njleg.state.nj.us/bill-search/2024/A1825