A5703

An Act concerning health benefits coverage of naloxone and supplementing various parts of the statutory law.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. a. A carrier shall ensure that every contract to provide prescription drug benefits, or to authorize the purchase of a contract to provide prescription drug benefits, shall provide coverage for naloxone to covered persons without the imposition of any prior authorization or other utilization management requirements, provided that the drug is:

(1) prescribed or administered to the covered person by a licensed medical practitioner who is authorized to prescribe or administer that treatment pursuant to State and federal law; or

(2) dispensed to the covered person by a licensed pharmacist under a standing order to dispense an opioid antidote pursuant P.L.2017, c.88 (C.45:14-67.2).

b. The provisions of this section shall not be construed to limit the coverage of naloxone only when administered by a medical practitioner.

c. As used in this section:

"Carrier" means 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.

“Naloxone” means a drug or device containing naloxone hydrochloride that is approved by the United States Food and Drug Administration for the treatment of an opioid overdose, either in the intramuscular or intranasal form and including a nasal atomizer if required to administer the drug.

2. a. The Division of Medical Assistance and Health Services in the Department of Human Services shall provide coverage for naloxone under the Medicaid program and the NJ FamilyCare program without the imposition of any prior authorization or other utilization management requirements, provided that the drug is:

(1) prescribed or administered to an enrollee by a licensed medical practitioner who is authorized to prescribe or administer that treatment pursuant to State and federal law; or

(2) dispensed to an enrollee by a licensed pharmacist under a standing order to dispense an opioid antidote pursuant P.L.2017, c.88 (C.45:14-67.2).

b. The provisions of this section shall not be construed to limit the coverage of naloxone only when administered by a medical practitioner.

c. The division shall require each managed care organization contracted with the division to provide pharmacy benefits to Medicaid and NJ FamilyCare enrollees to comply with the provisions of this section.

d. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this section and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.

e. As used in this section:

“Medicaid program” means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).

“NJ FamilyCare program” means the program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.).

3. a. Notwithstanding any law or regulation to the contrary, the State Health Benefits Commission and the School Employees’ Health Benefits Commission shall ensure that every contract under the State Health Benefits Program shall provide coverage for naloxone to eligible members of the State Health Benefits Program and the School Employees’ Health Benefits Program. The coverage shall be provided without the imposition of any prior authorization or other utilization management requirements, provided that the treatment is:

(1) prescribed or administered to the eligible member by a licensed medical practitioner who is authorized to prescribe or administer that treatment pursuant to State and federal law; or

(2) dispensed to the eligible member by a licensed pharmacist under a standing order to dispense an opioid antidote pursuant P.L.2017, c.88 (C.45:14-67.2).

b. The provisions of this section shall not be construed to limit the coverage of naloxone only when administered by a medical practitioner.

c. Each commission shall develop and issue guidelines to ensure the safety and efficacy of benefits provided pursuant to this section.

d. As used in this section:

4. This act shall take effect immediately and apply to every contract issued, renewed, or issued for renewal on or after that date, notwithstanding any federal approval required under the Medicaid and NJ FamilyCare programs pursuant to section 2 of this act.

STATEMENT

This bill would require certain health benefits carriers and State programs to provide coverage for naloxone without imposing prior authorization requirements. The goal of this bill is to broaden and expedite the availability of naloxone throughout the State, and to save lives in doing so.

Generally, naloxone is an inexpensive drug that reverses the effects of respiratory depression following heavy opioid use, resulting in a significantly decreased likelihood of death following an overdose. Under the bill, “naloxone” means a drug or device containing naloxone hydrochloride that is approved by the United States Food and Drug Administration for the treatment of an opioid overdose, either in the intramuscular or intranasal form and including a nasal atomizer if required to administer the drug. Specifically, this bill requires 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, as well as the Medicaid program, the NJ FamilyCare Program, the State Health Benefits Program, and the School Employees’ Health Benefits Program to provide coverage for naloxone without imposing prior authorization requirements or other utilization management requirements, provided that the treatment is:

(1) prescribed or administered to the eligible member by a licensed medical practitioner who is authorized to prescribe or administer that treatment pursuant to State and federal law; or

(2) dispensed to the eligible member by a licensed pharmacist under a standing order to dispense an opioid antidote pursuant to P.L.2017, c.88 (C.45:14-67.2), which allows pharmacists to dispense opioid antidotes to any person without an individual prescription

The bill explicitly states that its provisions are not be construed to limit the coverage of naloxone only when administered by a medical practitioner.

Administration of naloxone in a medical setting is standard practice for hospital medical staff and first responders caring for a patient who has overdosed on opioids. Currently, Medicaid covers naloxone, when administered in these settings, without prior authorization. This bill codifies that policy in the statutes.

Naloxone can also be prescribed directly to individuals. Currently, the New Jersey Board of Medical Examiners (BME) has issued a certificate of waiver allowing physicians and other prescribers to write a prescription for naloxone in the name of the person receiving the prescription, rather than the end user who will be administered the agent. As such, this bill allows individuals covered under the bill’s provisions, who are at risk of an opioid overdose or who may be in a position to assist others who are, to be covered for naloxone without prior authorization.