Bill
Bill > A5571
NJ A5571
NJ A5571Prohibits pre-approval or precertification of medical tests, procedures and prescription drugs covered under health benefits or prescription drug benefits plans.
summary
Introduced
04/10/2025
04/10/2025
In Committee
04/10/2025
04/10/2025
Crossed Over
Passed
Dead
01/12/2026
01/12/2026
Introduced Session
2024-2025 Regular Session
Bill Summary
This bill prohibits health insurers, third party administrators, pharmacy benefits managers, and the State Health Benefits Program and the School Employees' Health Benefits Program from requiring the pre-approval or precertification of medical tests, procedures or prescription drugs covered under a health benefits or prescription drug benefits plan. This bill will ensure that patients who are ill are not burdened with technical requirements by health benefits providers which employ utilization management review systems that slow down medical care. The sponsor is concerned that complaints from people who need medical treatment are on the rise, and feels that it is time to end the nightmare of the insurance company bureaucracy that is frustrating patients who need care and medicine. The so-called "pre-approval" process, now required by insurance companies, is a nightmare for patients across New Jersey. Historically, doctors would order a test or medicine and patients received it. Now, a myriad of bureaucratic obstacles makes patients and doctors pawns in a sad game of insurance-company chess. There are examples of cancer patients waiting for long periods of time to receive medicine because of a cumbersome and slow approval policy. The sponsor is convinced that it is time for the doctors to make decisions, not insurance companies; it is time for patients who are ill to not be burdened with technical requirements by insurance companies that employ systems that slow down medical care and are incredibly frustrating. It is the sponsor's goal that insurance companies pay for what the doctor orders.
AI Summary
This bill prohibits health insurance carriers, third-party administrators, pharmacy benefits managers, the State Health Benefits Program, and the School Employees' Health Benefits Program from requiring pre-approval or precertification for medical tests, procedures, or prescription drugs that are already covered under a health benefits plan and prescribed by a licensed healthcare provider. Pre-approval and precertification are administrative processes where insurance companies require prior authorization before covering a medical service or medication, which can delay patient care. The bill aims to eliminate these bureaucratic obstacles that can slow down medical treatment, particularly for patients with urgent medical needs like those undergoing cancer treatment. Under this proposed legislation, if a licensed healthcare provider prescribes a test, procedure, or prescription drug that is already included in a patient's health benefits plan, the insurance provider must pay for it without additional administrative hurdles. The bill would take effect immediately and apply to health benefits and prescription drug plans issued or purchased on or after its enactment date, with the ultimate goal of allowing doctors, rather than insurance companies, to make medical decisions and ensuring patients receive timely care.
Committee Categories
Business and Industry
Sponsors (3)
Last Action
Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 04/10/2025)
Official Document
bill text
bill summary
Loading...
bill summary
Loading...
bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.njleg.state.nj.us/bill-search/2024/A5571 |
| BillText | https://pub.njleg.gov/Bills/2024/A6000/5571_I1.HTM |
Loading...