Bill Text: NJ A4232 | 2024-2025 | Regular Session | Introduced
Bill Title: Prohibits prior authorization when prescribing certain drugs.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2024-05-02 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A4232 Detail]
Download: New_Jersey-2024-A4232-Introduced.html
Sponsored by:
Assemblywoman ROSAURA "ROSY" BAGOLIE
District 27 (Essex and Passaic)
SYNOPSIS
Prohibits prior authorization when prescribing certain drugs.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning prescription drugs 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. As used in this act:
"Brand name" means the proprietary or trade name assigned to a drug product by the manufacturer or distributor of the product.
"Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State or any entity contracted to administer health benefits in connection with the State Health Benefits Program or School Employees' Health Benefits Program.
"Generic version" means prescription drug product approved and designated by the United State Food and Drug Administration as therapeutic equivalents for reference listed drug products.
"Prior authorization" means the process used by carriers to determine the medical necessity of a covered service.
b. Notwithstanding any law, rule, or regulation to the contrary, a carrier shall not require prior authorization for prescribing an interchangeable drug if the brand name drug or generic version is not available.
2. This act shall take effect immediately.
STATEMENT
This bill prohibits the use of prior authorization under certain circumstances. "Prior authorization" is defined in the bill as a process used by a carrier to determine the medical necessity of an otherwise covered service. This bill prohibits the use of this process by a carrier for prescribing an interchangeable drug if the brand name drug or generic version is not available. "Carrier" is defined in the bill to mean an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State or any entity contracted to administer health benefits in connection with the State Health Benefits Program or School Employees' Health Benefits Program.
