ASSEMBLY APPROPRIATIONS COMMITTEE

STATEMENT TO

[Second Reprint]

SENATE, No. 2019

STATE OF NEW JERSEY

DATED:  DECEMBER 18, 2025

      The Assembly Appropriations Committee reports favorably Senate Bill No. 2019 (2R).

      As reported, this bill authorizes pharmacists to dispense HIV prophylaxis without an individual prescription under certain circumstances, and requires prescription benefits coverage for prophylaxis furnished under the bill.

      HIV prophylaxis is a course of treatment involving certain drugs or drug combinations that can prevent HIV infection notwithstanding exposure to the virus under circumstances in which it is normally transmitted.  HIV prophylaxis includes both HIV preexposure prophylaxis (PrEP), which is taken by a person who anticipates engaging in conduct that risks HIV infection, and HIV postexposure prophylaxis (PEP), which is taken by a person who may have been exposed to HIV.

      Under the bill, pharmacists will be permitted to furnish PrEP and PEP to patients without an individual prescription pursuant to a standing order issued by the Commissioner of Health or, if the commissioner is not a duly licensed physician, the Deputy Commissioner for Public Health Services.  A standing order will be issued to a pharmacist upon request, provided that the pharmacist completes a training program provided by the Department of Health or approved by the Department of Health, and certifies that the pharmacist will meet the requirements set forth in the bill to furnish PrEP and PEP without an individual prescription.  The training program is to include information about financial assistance programs available to patients to assist with the costs of PrEP and PEP.

      The bill allows a patient to receive up to a 90-day supply of PrEP without an individual prescription in any given two-year period.  Thereafter, to continue receiving PrEP, the patient will be required to obtain a prescription for the drugs.  A pharmacist furnishing PrEP to a patient without an individual prescription will be required to document that the patient is HIV negative, as demonstrated by a test administered in the past seven days, and that the patient does not report any signs or symptoms of acute HIV infection.  If the patient does not have a current HIV test, the pharmacist may administer an HIV test waived under federal law or order a test.  If the patient tests positive for HIV, the pharmacist will be required to provide the patient with information and resources concerning HIV treatment and comply with State and federal requirements for a positive HIV test, which includes certain reporting requirements.

      Additionally, the pharmacist will be required to confirm that the patient is not taking any contraindicated medications, provide the patient with counseling on the ongoing use of PrEP, advise the patient that the patient will require a prescription to continue receiving PrEP, confirm the patient has not already been provided with a 90-day supply of PrEP without an individual prescription in the past two years, document the services provided, and notify the patient’s primary care provider that the patient was furnished with PrEP, unless the patient does not consent to the pharmacist providing this notice. 

      Pharmacists may furnish a complete course of PEP to a patient who may have been exposed to HIV if the pharmacist confirms with the patient that the exposure to HIV occurred within the previous 72 hours, the patient otherwise meets the clinical criteria for PEP consistent with the standard of care in the guidelines published by the federal Centers for Disease Control and Prevention (CDC) or subsequent guidelines, the pharmacist tests the patient for HIV, the pharmacist counsels the patient on the use of PEP consistent with the standard of care in the CDC guidelines or subsequent guidelines, the pharmacist informs the patient of the availability of PrEP, and the pharmacist notifies the patient’s primary care provider the patient was furnished with PEP, unless the patient does not consent to the pharmacist providing this notice. 

      If a patient being furnished with PrEP or PEP does not have a primary care provider, or refuses to consent to the pharmacist providing notice to the primary care provider, the pharmacist will be required to provide the patient with:  a list of health care providers to contact regarding ongoing treatment using PrEP or follow-up care for PEP, as applicable; or an Internet web link to this information, which information the Department of Health is required to maintain and publish on the department’s Internet website for these purposes.

      In no case will a patient be authorized to waive the consultation required under the bill to receive PrEP or PEP without an individual prescription.

      Under the bill, a pharmacist ordering or providing HIV preexposure prophylaxis or HIV postexposure prophylaxis under these provisions is required to do so according to the same standards of care required under the federal guidelines promulgated by the CDC for a physician or other health care professional ordering or providing the identical service.

      As amended by the committee, the bill requires, in the event that the CDC PEP guidelines or the CDC PrEP guidelines are unavailable, the Department of Health will implement a process for establishing guidelines for pharmacists to order or provide HIV preexposure prophylaxis or HIV postexposure prophylaxis under the bill in accordance to the same standards of care, as applicable, for a physician or other health care professional ordering or providing the identical service.

      The bill explicitly provides that a licensed pharmacist who, in good faith, tests, furnishes or provides a patient care related to HIV preexposure prophylaxis and HIV postexposure prophylaxis pursuant to the bill, based on information provided by said patient or the patient's legal representative, is not to be subject to civil liability, criminal prosecution, disciplinary action, or other adverse action under any professional licensing statute for any injury or damages resulting from reliance on such information.

      The bill requires health benefits plans that include prescription benefits, as well as the State Employee’s Health Benefits Plan, the School Employees’ Health Benefits Plan, and Medicaid, to provide coverage for PrEP and PEP furnished under the bill without any prior authorization or step therapy requirements.  If therapeutic equivalents to prevent HIV and AIDS are authorized or approved by the federal Food and Drug Administration, the health plans may apply prior authorization or step therapy requirements to other versions of the treatment, provided at least one version is covered without prior authorization or step therapy. 

Reimbursements issued under the bill to a pharmacist are required to be at a rate that is no less than the rate provided by the health benefits plan to other non-physician practitioners, if the reimbursement is for a service or procedure that meets the following criteria: the service or procedure is within the scope of practice of the treating pharmacist; and the service or procedure would otherwise be covered under the health benefits plan if provided by a healthcare provider.

      A health benefits plan will be required to grant a licensed pharmacist receiving reimbursement under the bill the same rights of participation, plan admission, and registration as may be granted by the health benefits plan to a healthcare provider who is reimbursed for an identical service.  Health plans will not be authorized to prohibit a pharmacist from dispensing PrEP and PEP.  Health plans will not be required to provide coverage for PrEP furnished without an individual prescription in a quantity that exceeds a 90-day supply within a given two-year period.  Health plans will not be required to cover PrEP or PEP furnished by a pharmacist at an out-of-network pharmacy unless the plain includes an out-of-network pharmacy benefit.

      As reported by the committee, Senate Bill No. 2019 (2R) is identical to Assembly Bill No. 6293, which was also reported by the committee on this date.

FISCAL IMPACT:

      The Office of Legislative Services (OLS) concludes that authorizing pharmacists to dispense HIV prophylaxis to a patient once every two years without an individual prescription, when certain conditions are met, will increase annual State expenditures under the NJ FamilyCare program.  These costs would concomitantly increase annual State revenue in the form of federal Medicaid cost reimbursements.

      The OLS anticipates that requiring the State Health Benefits Program and the School Employees’ Health Benefits Program to provide coverage for HIV prophylaxis dispensed to a member once every two years without an individual prescription may increase State and local government expenditures by an indeterminate amount if more brand drugs are issued as a result of the bill.