Bill Text: NJ A5144 | 2016-2017 | Regular Session | Introduced
Bill Title: Requires health insurers to provide coverage for prescription drugs through entire course of treatment as determined by prescriber.
Spectrum: Slight Partisan Bill (Republican 2-1)
Status: (Introduced - Dead) 2017-08-24 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A5144 Detail]
Download: New_Jersey-2016-A5144-Introduced.html
Sponsored by:
Assemblywoman NANCY F. MUNOZ
District 21 (Morris, Somerset and Union)
Assemblywoman AMY H. HANDLIN
District 13 (Monmouth)
SYNOPSIS
Requires health insurers to provide coverage for prescription drugs through entire course of treatment as determined by prescriber.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning coverage for prescription drugs 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 benefits for expenses incurred in the purchase of prescription drugs 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 medically necessary prescription drugs through the covered person's entire course of treatment. The time period for the course of treatment shall be determined solely by the covered person's prescriber without the imposition of any utilization management requirements.
b. The benefits required by this section shall be provided to the same extent as for any other medical condition covered under the contract.
c. The provisions of this section shall apply to all contracts in which the hospital service corporation has reserved the right to change the premium.
d. As used in this section, "prescriber" means a licensed health care professional who is authorized to prescribe medication pursuant to State law.
2. a. A medical service corporation contract that provides benefits for expenses incurred in the purchase of prescription drugs 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 medically necessary prescription drugs through the covered person's entire course of treatment. The time period for the course of treatment shall be determined solely by the covered person's prescriber without the imposition of any utilization management requirements.
b. The benefits required by this section shall be provided to the same extent as for any other medical condition covered under the contract.
c. The provisions of this section shall apply to all contracts in which the medical service corporation has reserved the right to change the premium.
d. As used in this section, "prescriber" means a licensed health care professional who is authorized to prescribe medication pursuant to State law.
3. a. A health service corporation contract that provides benefits for expenses incurred in the purchase of prescription drugs 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 medically necessary prescription drugs through the covered person's entire course of treatment. The time period for the course of treatment shall be determined solely by the covered person's prescriber without the imposition of any utilization management requirements.
b. The benefits required by this section shall be provided to the same extent as for any other medical condition covered under the contract.
c. The provisions of this section shall apply to all contracts in which the health service corporation has reserved the right to change the premium.
d. As used in this section, "prescriber" means a licensed health care professional who is authorized to prescribe medication pursuant to State law.
4. a. An individual health insurance policy that provides benefits for expenses incurred in the purchase of prescription drugs 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 medically necessary prescription drugs through the covered person's entire course of treatment. The time period for the course of treatment shall be determined solely by the covered person's prescriber without the imposition of any utilization management requirements.
b. The benefits required by this section shall be provided to the same extent as for any other medical condition covered under the policy.
c. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
d. As used in this section, "prescriber" means a licensed health care professional who is authorized to prescribe medication pursuant to State law.
5. a. A group health insurance policy that provides benefits for expenses incurred in the purchase of prescription drugs 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 medically necessary prescription drugs through the covered person's entire course of treatment. The time period for the course of treatment shall be determined solely by the covered person's prescriber without the imposition of any utilization management requirements.
b. The benefits required by this section shall be provided to the same extent as for any other medical condition covered under the policy.
c. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
d. As used in this section, "prescriber" means a licensed health care professional who is authorized to prescribe medication pursuant to State law.
6. a. An individual health benefits plan that provides benefits for expenses incurred in the purchase of prescription drugs 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 medically necessary prescription drugs through the covered person's entire course of treatment. The time period for the course of treatment shall be determined solely by the covered person's prescriber without the imposition of any utilization management requirements.
b. The benefits required by this section shall be provided to the same extent as for any other medical condition covered under the health benefits plan.
c. The provisions of this section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
d. As used in this section, "prescriber" means a licensed health care professional who is authorized to prescribe medication pursuant to State law.
7. a. A small employer health benefits plan that provides benefits for expenses incurred in the purchase of prescription drugs 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 medically necessary prescription drugs through the covered person's entire course of treatment. The time period for the course of treatment shall be determined solely by the covered person's prescriber without the imposition of any utilization management requirements.
b. The benefits required by this section shall be provided to the same extent as for any other medical condition covered under the health benefits plan.
c. The provisions of this section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
d. As used in this section, "prescriber" means a licensed health care professional who is authorized to prescribe medication pursuant to State law.
8. a. A health maintenance organization enrollee agreement that provides benefits for expenses incurred in the purchase of prescription drugs 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 medically necessary prescription drugs through the covered person's entire course of treatment. The time period for the course of treatment shall be determined solely by the covered person's prescriber without the imposition of any utilization management requirements.
b. The benefits required by this section shall be provided to the same extent as for any other medical condition covered under the enrollee agreement.
c. The provisions of this section shall apply to those enrollee agreements in which the health maintenance organization has reserved the right to change the premium.
d. As used in this section, "prescriber" means a licensed health care professional who is authorized to prescribe medication pursuant to State law.
9. a. A prepaid prescription service organization contract that 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 medically necessary prescription drugs through the covered person's entire course of treatment. The time period for the course of treatment shall be determined solely by the covered person's prescriber without the imposition of any utilization management requirements.
b. The benefits required by this section shall be provided to the same extent as for any other medical condition covered under the contract.
c. The provisions of this section shall apply to those contracts in which the prepaid prescription service organization has reserved the right to change the premium.
d. As used in this section, "prescriber" means a licensed health care professional who is authorized to prescribe medication pursuant to State law.
10. a. The State Health Benefits Commission shall ensure that every contract that provides benefits for expenses incurred in the purchase of prescription drugs, which is purchased by the commission on or after the effective date of this act, shall provide coverage for medically necessary prescription drugs through the covered person's entire course of treatment. The time period for the course of treatment shall be determined solely by the covered person's prescriber without the imposition of any utilization management requirements.
b. The benefits required by this section shall be provided to the same extent as for any other medical condition covered under the contract.
c. As used in this section, "prescriber" means a licensed health care professional who is authorized to prescribe medication pursuant to State law.
11. a. The School Employees' Health Benefits Commission shall ensure that every contract that provides benefits for expenses incurred in the purchase of prescription drugs, which is purchased by the commission on or after the effective date of this act, shall provide coverage for medically necessary prescription drugs through the covered person's entire course of treatment. The time period for the course of treatment shall be determined solely by the covered person's prescriber without the imposition of any utilization management requirements.
b. The benefits required by this section shall be provided to the same extent as for any other medical condition covered under the contract.
c. As used in this section, "prescriber" means a licensed health care professional who is authorized to prescribe medication pursuant to State law.
12. This act shall take effect on the 90th day next following enactment.
STATEMENT
This bill requires health insurance carriers to provide coverage for medically necessary prescription drugs through the covered person's entire course of treatment, as determined by the prescriber.
The bill requires hospital, medical, and health service corporations, commercial insurers, health maintenance organizations, health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits programs, prepaid prescription service organizations, and plans provided by the State Health Benefits Commission and the School Employees' Health Benefits Commission, to provide coverage for medically necessary prescription drugs through the covered person's entire course of treatment. The time period for the course of treatment shall be determined solely by the covered person's prescriber without the imposition of any utilization management requirements.
