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Bill > S4283
NJ S4283
NJ S4283Prohibits health insurance carriers from denying coverage of nonopioid prescription drugs in favor of opioid prescription drugs.
summary
Introduced
05/14/2026
05/14/2026
In Committee
05/14/2026
05/14/2026
Crossed Over
Passed
Dead
Introduced Session
2026-2027 Regular Session
Bill Summary
This bill makes it unlawful when a licensed health care provider prescribes a nonopioid medication to a person covered by a health insurance carrier for the treatment of acute pain and the carrier denies coverage of a nonopioid prescription drug: (1) in favor of an opioid prescription drug; or (2) to require a covered person to try an opioid prescription drug prior to approving the use of a nonopioid prescription drug. "Carrier" is defined in the bill to mean an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State. Under the bill, a carrier that establishes and maintains a drug formulary is to ensure that a nonopioid drug approved by the United States Food and Drug Administration for the treatment or management of pain will not be disadvantaged or discouraged, with respect to coverage or cost-sharing, relative to any opioid or narcotic drug for the treatment or management of pain on the formulary of the carrier under various circumstances. It is not prohibited in the bill for an opioid drug to be preferred over another opioid drug or for a nonopioid drug to be preferred over another nonopioid drug. The provisions of the bill prohibiting denial of a nonopioid prescription drug are also incorporated into the laws governing the required coverage for contracts negotiated by the State Health Benefits Commission and the School Employees' Health Benefits Commission, and in the law overseeing Medicaid.
AI Summary
This bill makes it unlawful for health insurance carriers, including insurance companies and health maintenance organizations, to deny coverage for nonopioid prescription drugs when a licensed healthcare provider prescribes them for acute pain treatment, either by favoring opioid drugs or by requiring patients to try opioids first. It also mandates that if a carrier uses a drug formulary, which is a list of covered drugs, nonopioid pain medications approved by the FDA must not be disadvantaged in terms of coverage or out-of-pocket costs compared to opioid drugs. This prohibition against disadvantaging nonopioid drugs applies to coverage criteria, authorization requirements, and cost-sharing tiers, though it does not prevent preferring one nonopioid over another or one opioid over another. These provisions are also extended to contracts managed by the State Health Benefits Commission and the School Employees' Health Benefits Commission, as well as to the Medicaid program, ensuring that nonopioid pain medications are not unfairly denied or made more difficult to access than opioid alternatives for individuals covered by these plans.
Committee Categories
Business and Industry
Sponsors (1)
Last Action
Introduced in the Senate, Referred to Senate Commerce Committee (on 05/14/2026)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.njleg.state.nj.us/bill-search/2026/S4283 |
| BillText | https://pub.njleg.gov/Bills/2026/S4500/4283_I1.HTM |
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