Bill Text: NJ S3128 | 2024-2025 | Regular Session | Introduced
Bill Title: Requires health benefits plans to cover abuse-deterrent opioid analgesic drug products.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2024-04-15 - Introduced in the Senate, Referred to Senate Commerce Committee [S3128 Detail]
Download: New_Jersey-2024-S3128-Introduced.html
Sponsored by:
Senator BRIAN P. STACK
District 33 (Hudson)
SYNOPSIS
Requires health benefits plans to cover abuse-deterrent opioid analgesic drug products.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning prior authorization of abuse-deterrent opioid medications 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. a. A carrier that offers a health benefits plan in this State shall provide coverage and benefits, on its prescription drug formulary list, for at least one abuse-deterrent opioid analgesic drug product per opioid analgesic active ingredient.
(1) Cost-sharing for a brand-name abuse-deterrent opioid analgesic drug product covered pursuant to this act shall not exceed the lowest cost-sharing amount applied to a brand-name non-abuse deterrent opioid drug covered under the applicable health benefits plan.
(2) Cost-sharing for a generic abuse-deterrent opioid analgesic drug product covered pursuant to this act shall not exceed the lowest cost-sharing level applied to a generic non abuse-deterrent opioid drug covered under the applicable health benefits plan.
(3) An increase in patient cost-sharing or disincentives for prescribers or dispensers shall be prohibited pursuant to this act.
b. Any prior-authorization requirements or other utilization review requirements for an opioid analgesic, and any service denials made thereunder, shall not require a covered person or enrollee to use an opioid analgesic drug product without abuse-deterrent properties before a covered person or enrollee can access an abuse-deterrent opioid analgesic drug product.
c. As used in this act:
"Abuse-deterrent opioid analgesic drug product" means a brand-name or generic opioid analgesic drug product approved by the federal Food and Drug Administration with abuse-deterrence labeling claims indicating that the drug product has abuse-deterrent properties that are expected to deter or reduce abuse of the drug product.
"Carrier" means an insurance company, hospital service corporation, medical service corporation, health service corporation, health maintenance organization authorized to issue health benefits plans in this State, and any entities contracted to administer health benefits in connection with the State Health Benefits Program and School Employees' Health Benefits Program
"Cost-sharing" means any coverage limit, copayment, coinsurance, deductible or other out-of-pocket patient expense requirement.
"Opioid analgesic drug product" means a drug in the opioid analgesic drug class prescribed to treat moderate to severe pain or other conditions, whether in immediate release or extended long acting release form and whether or not combined with other drug substances to form a single drug product or other dosage form.
2. This act shall take effect on the 90th day next following enactment and shall apply to policies and contracts that are delivered, issued, executed, or renewed on or after that date.
STATEMENT
This bill requires health benefits plans to cover abuse-deterrent analgesic opioid drug products.
Under the bill, a carrier will be required to provide coverage and benefits, on its prescription drug formulary list, for at least one abuse-deterrent opioid analgesic drug product per opioid analgesic active ingredient.
The bill also provides that cost-sharing for a brand name or generic abuse-deterrent opioid analgesic drug product is not to exceed the lowest cost-sharing amount applied to a brand name or generic non-abuse deterrent opioid drug, respectively.
Finally, the bill provides that any prior-authorization requirements or other utilization review requirements for an opioid analgesic, and any service denials made thereunder, are prohibited from requiring a covered person or enrollee to use an opioid analgesic drug product without abuse-deterrent properties before a covered person or enrollee can access an abuse-deterrent opioid analgesic drug product.
