§1
C.26:2S-38
§2
C.30:4D-6q
§3
C.52:14-17.29ff
§4
Note
An Act concerning health benefits coverage of 1[naloxone] opioid antidotes1 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 1[naloxone] an opioid antidote1 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 1to section 1 of1 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 1[naloxone] an opioid antidote1 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.
1[“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] “Opioid antidote" means naloxone hydrochloride, or any other similarly acting drug approved by the United States Food and Drug Administration for self-administration for the treatment of an opioid overdose1.
2. a. The Division of Medical Assistance and Health Services in the Department of Human Services shall provide coverage for 1[naloxone] an opioid antidote1 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 1to section 1 of1 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 1[naloxone] an opioid antidote1 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.).
1[“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] “Opioid antidote" means naloxone hydrochloride, or any other similarly acting drug approved by the United States Food and Drug Administration for self-administration for the treatment of an opioid overdose1.
“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 1[naloxone] an opioid antidote1 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 1to section 1 of1 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 1[naloxone] an opioid antidote1 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:
1[“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] “Opioid antidote" means naloxone hydrochloride, or any other similarly acting drug approved by the United States Food and Drug Administration for self-administration for the treatment of an opioid overdose1.
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.
Requires certain health insurers, Medicaid, NJ FamilyCare, SHBP, and SEHBP to cover opioid antidote without imposing prior authorization requirements.