Sponsored by:
Assemblyman HERB CONAWAY, JR.
District 7 (Burlington)
Assemblywoman VALERIE VAINIERI HUTTLE
District 37 (Bergen)
Assemblyman RAJ MUKHERJI
District 33 (Hudson)
Co-Sponsored by:
Assemblyman Benson, Assemblywomen Pinkin, Jimenez, Assemblyman Tully and Assemblywoman McKnight
SYNOPSIS
Requires health insurance carriers to provide list of alternative drugs to health care professionals and covered persons under certain circumstances.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning prescription drug benefit coverage and supplementing P.L.1997, c.192 (C.26:2S-1 et al.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. A carrier that offers a health benefits plan in this State which provides coverage for pharmacy services, prescription drugs, or for participation in a prescription drug plan, shall provide to a prescribing health care professional and to a covered person, in a situation in which the carrier denies a covered person’s coverage for a drug prescribed by the health care professional, a written list of all alternative drugs that are covered by the health benefits plan and that are interchangeable with, and therapeutically equivalent to, the drug for which coverage was denied. The carrier shall provide the list of alternative drugs along with the explanation of benefits or other notice of the denial of coverage. For purposes of this section, “health care professional” means a person licensed to practice a health care profession pursuant to Title 45 of the Revised Statutes.
2. This act shall take effect on the 90th day next following the date of enactment.
STATEMENT
This bill supplements the “Health Care Quality Act” to require a carrier that offers a health benefits plan in this State which provides coverage for pharmacy services, prescription drugs, or for participation in a prescription drug plan, to provide to a prescribing health care professional and to a covered person, in a situation in which the carrier denies a covered person’s coverage for a drug prescribed by the health care professional, a written list of all alternative drugs that are covered by the health benefits plan and that are interchangeable with, and therapeutically equivalent to, the drug for which coverage was denied. The carrier shall provide the list of alternative drugs along with the explanation of benefits or other notice of the denial of coverage.