Bill Text: NJ A4138 | 2016-2017 | Regular Session | Introduced
Bill Title: Requires health benefits coverage for buprenorphine and buprenorphine/naloxone under certain conditions.
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Introduced - Dead) 2016-09-19 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A4138 Detail]
Download: New_Jersey-2016-A4138-Introduced.html
Sponsored by:
Assemblyman HERB CONAWAY, JR.
District 7 (Burlington)
Assemblyman JOSEPH A. LAGANA
District 38 (Bergen and Passaic)
Assemblyman DANIEL R. BENSON
District 14 (Mercer and Middlesex)
SYNOPSIS
Requires health benefits coverage for buprenorphine and buprenorphine/naloxone under certain conditions.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health benefits coverage for buprenorphine and buprenorphine/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 hospital service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of opioid addiction. Coverage provided pursuant to this section shall not be subject to any prior authorization, dollar limit, copayment, deductible, or coinsurance.
b. The provisions of this section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
2. a. A medical service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of opioid addiction. Coverage provided pursuant to this section shall not be subject to any prior authorization, dollar limit, copayment, deductible, or coinsurance.
b. The provisions of this section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
3. a. A health service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of opioid addiction. Coverage provided pursuant to this section shall not be subject to any prior authorization, dollar limit, copayment, deductible, or coinsurance.
b. The provisions of this section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.
4. a. An individual health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of opioid addiction. Coverage provided pursuant to this section shall not be subject to any prior authorization, dollar limit, copayment, deductible, or coinsurance.
b. The provisions of this section shall apply to those policies in which the insurer has reserved the right to change the premium.
5. a. A group health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of opioid addiction. Coverage provided pursuant to this section shall not be subject to any prior authorization, dollar limit, copayment, deductible, or coinsurance.
b. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
6. a. An individual health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of opioid addiction. Coverage provided pursuant to this section shall not be subject to any prior authorization, dollar limit, copayment, deductible, or coinsurance.
b. The provisions of this section shall apply to all individual health benefits plans in which the carrier has reserved the right to change the premium.
7. a. A small employer health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of opioid addiction. Coverage provided pursuant to this section shall not be subject to any prior authorization, dollar limit, copayment, deductible, or coinsurance.
b. The provisions of this section shall apply to all small employer health benefits plans in which the carrier has reserved the right to change the premium.
8. a. A health maintenance organization contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for any expenses incurred by an enrollee for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of opioid addiction. Coverage provided pursuant to this section shall not be subject to any prior authorization, dollar limit, copayment, deductible, or coinsurance.
b. The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the health maintenance organization has reserved the right to change the schedule of charges.
9. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of opioid addiction. Coverage provided pursuant to this section shall not be subject to any prior authorization, dollar limit, copayment, deductible, or coinsurance.
10. The School Employees'
Health Benefits Commission shall ensure that every contract purchased by the
commission on or after the effective date of this act that provides hospital or
medical expense benefits shall provide coverage for any expenses incurred by a
covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the
treatment of opioid addiction. Coverage provided pursuant to this
section shall not be subject to any prior authorization, dollar limit, copayment,
deductible, or coinsurance.
11. This act shall take effect on the 90th day after enactment.
STATEMENT
This bill requires health insurers (health, hospital and medical service corporations, commercial individual and group health insurers; health maintenance organizations, health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs, the State Health Benefits Program, and the School Employees' Health Benefits Program) to provide health benefits coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of opioid addiction. The bill provides that coverage is not subject to any prior authorization, dollar limit, copayment, deductible, or coinsurance.
Buprenorphine, commonly referred to by the brand name, Subutex, and buprenorphine/naloxone, commonly referred to by the brand name Suboxone, are medications used to treat opioid dependence. This bill seeks to make these medications more readily available and affordable for people with opioid dependence issues that have insurance and are seeking treatment.
