STATE OF NEW JERSEY
220th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2022 SESSION
Sponsored by:
Senator ANTHONY M. BUCCO
District 25 (Morris and Somerset)
Senator JON M. BRAMNICK
District 21 (Morris, Somerset and Union)
SYNOPSIS
Prohibits pre-approval or precertification of cancer treatments, tests, procedures and prescription drugs covered under health benefits or prescription drug benefits plans.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning pre-approval and precertification of certain health and pharmacy benefits and supplementing various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Notwithstanding the provisions of any other law, rule or regulation to the contrary, a carrier shall not condition the payment of any benefit for any treatment, test, procedure, or prescription drug, upon any pre-approval or precertification of any kind by the carrier if that treatment, test, procedure, or prescription drug is otherwise covered under the health benefits plan and it has been prescribed by a licensed health care provider for a covered individual who has been diagnosed with cancer.
2. Notwithstanding the provisions of any other law, rule or regulation to the contrary, a third party administrator shall not condition the payment of any benefit for any treatment, test, procedure, or prescription drug, upon any pre-approval or precertification of any kind by the third party administrator or benefits payer if that treatment, test, procedure, or prescription drug is otherwise covered under the health benefits plan and it has been prescribed by a licensed health care provider for a covered individual who has been diagnosed with cancer.
3. Notwithstanding the provisions of any other law, rule or regulation to the contrary, a pharmacy benefits manager shall not condition the payment of any benefit for a prescription drug, upon any pre-approval or precertification of any kind by the pharmacy benefits manager, carrier or purchaser if that prescription drug is otherwise covered under the health benefits plan and it has been prescribed by a licensed health care provider for a covered individual who has been diagnosed with cancer.
4. Notwithstanding the provisions of any other law, rule or regulation to the contrary, a contract for health benefits, or for prescription drug benefits, purchased by the State Health Benefits Program shall not condition the payment of any benefit for any treatment, test, procedure, or prescription drug, upon any pre-approval or precertification of any kind if that treatment, test, procedure, or prescription drug is otherwise covered under the health benefits plan and it has been prescribed by a licensed health care provider for a covered individual who has been diagnosed with cancer.
5. Notwithstanding the provisions of any other law, rule or regulation to the contrary, a contract for health benefits, or for prescription drug benefits, purchased by the School Employees' Health Benefits Program shall not condition the payment of any benefit for any treatment, test, procedure, or prescription drug, upon any pre-approval or precertification of any kind if that treatment, test, procedure, or prescription drug is otherwise covered under the health benefits plan and it has been prescribed by a licensed health care provider for a covered individual who has been diagnosed with cancer.
6. This act shall take effect immediately and apply to health benefits plans or prescription drug benefits plans issued or purchased on or after that date.
STATEMENT
This bill prohibits health insurers, third party administrators, pharmacy benefits managers, and the State Health Benefits Program and the School Employees' Health Benefits Program from requiring the pre-approval or precertification of treatments, tests, procedures, or prescription drugs covered under a health benefits or prescription drug benefits plan when prescribed for a covered individual who has been diagnosed with cancer. This bill will ensure that cancer patients are not burdened with technical requirements by health benefits providers which employ utilization management review systems that slow down medical care.
The sponsor is concerned that complaints from people who need medical treatment are on the rise, and feels that it is time to end the nightmare of the insurance company bureaucracy that is frustrating patients who need care and medicine. The so-called "pre-approval" process, now required by insurance companies, is a nightmare for patients across New Jersey. Historically, doctors would order a treatment, test, or medicine and patients received it. Now, a myriad of bureaucratic obstacles makes patients and doctors pawns in a sad game of insurance-company chess. There are examples of cancer patients waiting for long periods of time to receive treatments or medicine because of a cumbersome and slow approval policy.
The sponsor is convinced that it is time for the doctors to make decisions, not insurance companies; it is time for patients who have been diagnosed with cancer to not be burdened with technical requirements by insurance companies that employ systems that slow down medical care and are incredibly frustrating. It is the sponsor's goal that insurance companies pay for what the doctor orders.