Bill > S3533

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' medical needs while managing healthcare costs. The legislation requires step therapy protocols to be based on rigorous clinical practice guidelines developed by multidisciplinary expert panels using objective data, high-quality research, and a transparent process that minimizes conflicts of interest. Health insurers and managed care organizations must provide a clear, accessible process for patients and healthcare providers to request exceptions to step therapy protocols when the required medications might cause adverse reactions, be ineffective, or potentially harm the patient. The bill mandates that when an exception is granted, the prescribed medication will be covered for at least 180 days, and insurers must respond to exception requests within 24 hours for urgent cases and 72 hours for non-urgent cases. Additionally, the bill requires insurance providers to make statistics about step therapy exception requests publicly available on their websites, promoting transparency in the process. The legislation is designed to preserve healthcare providers' ability to make medically necessary treatment decisions while still allowing insurers to manage prescription drug costs through controlled, scientifically-backed step therapy protocols.

Budget and Finance, Business and Industry

https://www.njleg.state.nj.us/bill-search/2024/S3533