Bill Text: NJ A5270 | 2026-2027 | Regular Session | Introduced
Bill Title: Requires coverage of clinician-administered drugs without additional financial penalties or certain limitations on location of administration of drugs.
Sponsorship: Partisan Bill (Democrat 2)
Status: (Introduced) 2026-06-15 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A5270 Detail]
Download: New_Jersey-2026-A5270-Introduced.html
Sponsored by:
Assemblywoman CAROL A. MURPHY
District 7 (Burlington)
Assemblyman ANTHONY ANGELOZZI
District 8 (Atlantic and Burlington)
SYNOPSIS
Requires coverage of clinician-administered drugs without additional financial penalties or certain limitations on location of administration of drugs.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning patient choice in dispensing of certain prescription drugs and biologics and supplementing P.L.1997, c.192 (C.26:2S-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. As used in this act:
"Clinician-administered drug" means a prescription drug or biologic other than a vaccine that:
(1) cannot reasonably be self-administered by the patient to whom the drug is prescribed or by an individual assisting the patient with the self-administration; and
(2) is typically administered:
(a) by a health care provider authorized under the laws of this State to administer the drug, including when acting under the delegation and supervision of a physician;
(b) in a physician 's office, hospital outpatient infusion center, or other clinical setting; and
(c) only after a comprehensive pharmacist review in accordance with a patient care treatment plan.
2. A carrier or pharmacy benefits manager shall not:
a. refuse to authorize, approve, or pay a participating health care provider for issuing covered clinician-administered drugs and related services to covered persons;
b. impose coverage or benefits limitations, or require a covered person to pay an additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or other penalty when obtaining clinician-administered drugs from a health care provider authorized under the laws of this State to administer clinician-administered drugs, or a pharmacy;
c. interfere with the covered person's right to choose to obtain a clinician-administered drug from the health care provider or pharmacy of choice, including inducement, steering, or offering financial or other incentives;
d. require clinician-administered drugs to be dispensed by a pharmacy selected by the carrier or pharmacy benefits manager;
e. limit or exclude coverage for a clinician-administered drug when not dispensed by a pharmacy selected by the carrier or pharmacy benefits manager if the drug would otherwise be covered;
f. reimburse at a lesser amount clinician-administered drugs dispensed by a pharmacy not selected by the carrier or pharmacy benefits manager; or
g. require a pharmacy to dispense a clinician-administered medication directly to a covered person with the intention that the covered person will transport the medication to a healthcare provider for administration.
For purposes of this section, the location of administering the clinician-administered drug shall not be included as part of the criteria reviewed to determine medical necessity.
3. A carrier or pharmacy benefits manager may offer, but shall not require, the use of:
a. a home infusion pharmacy to dispense clinician-administered drugs to covered persons in their homes; or
b. an infusion site external to the office or clinic of the covered person's health care provider.
4. The Commissioner of Banking and Insurance may, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), promulgate rules and regulations to effectuate the provisions of this act.
5. This act shall take effect on the first day of the seventh month next and shall apply to contracts or policies issued or renewed on or after the date of enactment.
STATEMENT
This bill establishes certain prohibitions for a carrier and pharmacy benefits manager in providing coverage for clinician-administered drugs and related services to persons covered under the plan or by the pharmacy benefits manager. Specifically, a carrier and a pharmacy benefits manager may not, among other items: (1) refuse to authorize, approve, or pay a participating health care provider for issuing covered clinician-administered drugs and related services to covered persons; (2) interfere with a covered person's right to choose to obtain a clinician-administered drug from the health care provider or pharmacy of choice; and (3) limit or exclude coverage for a clinician-administered drug when not dispensed by a pharmacy selected by the carrier or pharmacy benefits manager if the drug would otherwise be covered.
Under the bill, a carrier or pharmacy benefits manager may offer, but is not to require, the use of: (1) a home infusion pharmacy to dispense clinician-administered drugs to covered persons in their homes; or (2) an infusion site external to the office or clinic of the covered person's health care provider.
