Bill Text: NJ S4201 | 2026-2027 | Regular Session | Introduced
Bill Title: Authorizes coverage of prescriptive hormone replacement therapy.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced) 2026-05-11 - Introduced in the Senate, Referred to Senate Commerce Committee [S4201 Detail]
Download: New_Jersey-2026-S4201-Introduced.html
Sponsored by:
Senator RAJ MUKHERJI
District 32 (Hudson)
SYNOPSIS
Authorizes coverage of prescriptive hormone replacement therapy.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning prescriptive hormone replacement therapy and supplementing P.L.1997, c.192 (C.26:2S-1 et seq.) and P.L.1968, c.413 (C.30:4D-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A health benefits plan of a carrier or a contract for hospital and medical expense benefits purchased by the State Health Benefits Commission or the School Employees' Health Benefits Commission shall provide benefits to a covered person for a 12-month refill of prescription hormone replacement therapy if the prescription therapy does not require refrigeration.
b. If a prescription hormone replacement therapy is a controlled dangerous substance, a health benefits plan of a carrier or a contract for hospital and medical expense benefits purchased by the State Health Benefits Commission or the School Employees' Health Benefits Commission shall provide the maximum refill allowed under State and federal law that may be obtained at one time by a covered person.
c. Nothing in this section prohibits a health benefits plan of a carrier or a contract for hospital and medical expense benefits purchased by the State Health Benefits Commission or the School Employees' Health Benefits Commission from limiting refills that may be obtained in the last quarter of the plan year if a 12-month supply of the prescription hormone replacement therapy has already been dispensed during the plan year.
d. Nothing in this section prohibits a prescribing provider from temporarily limiting refills that may be obtained at one time to a 90-day supply if the prescription hormone replacement therapy is experiencing an acute dispensing shortage during the plan year, provided that limits shall be rescinded at first opportunity of a regularly reinstated, sustainable supply.
e. To the extent not otherwise prohibited under this section or State or federal law, a health benefits plan of a carrier or a contract for hospital and medical expense benefits purchased by the State Health Benefits Commission or the School Employees' Health Benefits Commission may apply drug utilization management strategies to prescription drugs covered under subsection a. of this section.
f. For purposes of this
section, "prescription hormone replacement therapy" means all drugs approved by
the United States Food and Drug Administration that are used to medically
suppress, increase, or replace hormones that the body is not producing at
intended levels. "Prescription hormone replacement therapy" shall not include
glucagon-like peptide-1 and glucagon-like peptide-1 receptor agonists.
2. a. Notwithstanding any State law or regulation to the contrary, the Department of Human Services shall ensure that expenses incurred for a 12-month refill of prescription hormone replacement therapy if the prescription therapy does not require refrigeration shall be provided with no cost-sharing to persons served under the Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
b. If a prescription hormone replacement therapy is a controlled dangerous substance, the maximum refill allowed under State and federal law may be obtained at one time by persons served under the Medicaid program.
c. Nothing in this section shall prohibit a limitation on refills that may be obtained in the last quarter of the plan year if a 12-month supply of the prescription hormone replacement therapy has already been dispensed during the plan year.
d. Nothing in this section prohibits a temporary limit on refills that may be obtained at one time to a 90-day supply if the prescription hormone replacement therapy is experiencing an acute dispensing shortage during the plan year, provided that limits shall be rescinded at first opportunity of a regularly reinstated, sustainable supply.
e. For purposes of this section, "prescription hormone replacement therapy" means all drugs approved by the United States Food and Drug Administration that are used to medically suppress, increase, or replace hormones that the body is not producing at intended levels. "Prescription hormone replacement therapy" shall not include glucagon-like peptide-1 and glucagon-like peptide-1 receptor agonists.
3. This act shall take effect immediately and shall apply to health benefits plans and contracts issued or renewed on or after the date of enactment.
STATEMENT
This bill requires a health benefits plan of a carrier; a contract for hospital and medical expense benefits purchased by the State Health Benefits Commission or the School Employees' Health Benefits Commission; and Medicaid to provide benefits to a covered person for a 12-month refill of prescription hormone replacement therapy if the prescription therapy does not require refrigeration. In the bill, "prescription hormone replacement therapy" means all drugs approved by the United States Food and Drug Administration that are used to medically suppress, increase, or replace hormones that the body is not producing at intended levels but excludes glucagon-like peptide-1 and glucagon-like peptide-1 receptor agonists.
Under the bill, if a prescription hormone replacement therapy is a controlled dangerous substance, a health benefits plan of a carrier; a contract for hospital and medical expense benefits purchased by the State Health Benefits Commission or the School Employees' Health Benefits Commission; and Medicaid are to provide the maximum refill allowed under State and federal law that may be obtained at one time by a covered person. A health benefits plan of a carrier; a contract for hospital and medical expense benefits purchased by the State Health Benefits Commission or the School Employees' Health Benefits Commission; and Medicaid are not prohibited from limiting refills that may be obtained in the last quarter of the plan year if a 12-month supply of the prescription hormone replacement therapy has already been dispensed during the plan year.
Nothing in the bill is to prohibit a prescribing provider from temporarily limiting refills that may be obtained to a 90-day supply at one time if the prescription hormone replacement therapy is experiencing an acute dispensing shortage during the plan year, provided the limits are to be rescinded at first opportunity of a regularly reinstated, sustainable supply. To the extent not otherwise prohibited under the bill or State or federal law, a health benefits plan of a carrier or a contract for hospital and medical expense benefits purchased by the State Health Benefits Commission or the School Employees' Health Benefits Commission may apply drug utilization management strategies to prescription drugs.
