ASSEMBLY AGING AND HUMAN SERVICES COMMITTEE

STATEMENT TO

with committee amendments

ASSEMBLY, No. 5409

STATE OF NEW JERSEY

DATED:  DECEMBER 4, 2025

      The Assembly Aging and Human Services Committee reports favorably and with committee amendments Assembly Bill No. 5409.

      As amended, this bill requires that NJ FamilyCare reimbursement for long-acting injectable antipsychotic drugs administered in an inpatient setting be separate and distinct from any reimbursement issued to an inpatient provider based on a Diagnostic Related Group reimbursement system.  Additionally, under the bill, the inpatient reimbursement rate of these drugs is mandated to be equal to the identical drug’s NJ FamilyCare reimbursement rate when administered in an outpatient setting.  Long-acting injectable antipsychotic drugs can treat and manage symptoms of major psychiatric disorders, such as schizophrenia and bipolar disorder, for up to 24 weeks with a single dose.  While expensive medications, these drugs have significant benefits for the patient and health care system, including:  improved medication adherence, reduced hospitalizations and need for medical intervention, and improved clinical outcomes.

     Currently, NJ FamilyCare uses Diagnosis Related Groups (DRGs) to reimburse inpatient providers, such as general acute care hospitals, a fixed amount for inpatient services.  DRGs are a classification system that group hospital services based on similar diagnoses and procedures, as well as age, sex, and discharge status, in order to determine a reimbursement rate.  Reimbursement for the administration of a long-acting injectable antipsychotic drug in an inpatient setting is included within this payment; however, the high cost of these drugs is not considered in the methodology that establishes the DRG payment amount. 

     Alternatively, the reimbursement rate for long-acting injectable antipsychotic drugs in an outpatient setting is largely based on the ingredient cost of the drug.  Therefore, the provisions of the bill ensure that inpatient providers receive a reimbursement payment for long-acting injectable antipsychotic drugs that is more closely reflective of the cost of the drug. 

      The bill also allows pharmacists to administer a long-acting antipsychotic injectable drug, pursuant to a prescription issued by an authorized prescriber, provided the pharmacist is appropriately educated and qualified to administer the drug, as determined by the State Board of Pharmacy.

COMMITTEE AMENDMENTS:

      The committee amended the bill to allow pharmacists to administer a long-acting antipsychotic injectable drug, pursuant to a prescription issued by an authorized prescriber, provided the pharmacist is appropriately educated and qualified to administer the drug, as determined by the State Board of Pharmacy.