ASSEMBLY FINANCIAL INSTITUTIONS AND INSURANCE COMMITTEE

STATEMENT TO

ASSEMBLY, No. 4838

with committee amendments

STATE OF NEW JERSEY

DATED:  APRIL 10, 2025

      The Assembly Financial Institutions and Insurance Committee reports favorably and with committee amendments Assembly Bill No. 4838.

      As amended, this bill requires health insurance carriers and the State Medicaid and NJ FamilyCare programs to provide coverage for a prescription drug prescribed for serious mental illness to covered persons without the imposition of any prior authorization or other utilization management requirements, including, but not limited to, a step therapy protocol, if the prescriber is:

      (1)  a psychiatrist; or

      (2)  an obstetrician/gynecologist, during the postpartum period.

      The bill provides that if a person has been stable and appropriately treated for a serious mental illness using a drug prescribed by a psychiatrist or an obstetrician/gynecologist for a period of six months, another prescriber may continue prescribing that drug without prior authorization or utilization management requirements.  The bill also provides that the requirement for coverage of drugs for serious mental illness without prior authorization or utilization management only applies to persons who are 18 years of age or older.

      Under the bill, “carrier" is defined 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.

      As amended and reported by the committee, Assembly Bill No. 4838 is identical to Senate Bill No. 1192 (3R).

COMMITTEE AMENDMENTS:

      The committee amended the bill to:

      (1)  revise the definition of “serious mental illness;”

      (2)  provide that coverage for drugs prescribed for serious mental illness to covered persons without prior authorization or utilization management is only required if the drug is prescribed by a psychiatrist or an obstetrician/gynecologist, during the postpartum period;

      (3)  provide that if a person has been stable and appropriately treated for a serious mental illness using a drug prescribed by a psychiatrist or an obstetrician/gynecologist for a period of six months, another prescriber may continue prescribing that drug without prior authorization or utilization management requirements; and

      (4)  provide that the requirement for coverage of drugs for serious mental illness without prior authorization or utilization management only applies to persons who are 18 years of age or older.