STATE OF NEW JERSEY
222nd LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION
Sponsored by:
Assemblyman MICHAEL VENEZIA
District 34 (Essex)
Assemblywoman VERLINA REYNOLDS-JACKSON
District 15 (Hunterdon and Mercer)
Assemblywoman HEATHER SIMMONS
District 3 (Cumberland, Gloucester and Salem)
Co-Sponsored by:
Assemblyman Kearney
SYNOPSIS
Prohibits SHBP, SEHBP, and Medicaid from denying coverage for maintenance medications for chronic conditions for covered persons solely because of change in health benefits plan or pharmacy benefits manager.
CURRENT VERSION OF TEXT
As reported by the Assembly Financial Institutions and Insurance Committee with technical review.
An Act concerning health care coverage for certain medications and supplementing P.L.1961, c.49 (C.52:14-17.25 et seq.), P.L.2007, c.103 (C.52:14-17.46.1 et seq.), and P.L.1968, c.413 (C.30:4D-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Notwithstanding any other law or regulation to the contrary, the State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall not deny coverage for a maintenance medication prescribed by a covered person’s physician for the covered person’s chronic condition because of a change in the covered person’s pharmaceutical benefits that results solely from a change in the contract or the pharmacy benefits manager for that contract if:
a. the covered person was taking the medication prior to the date of the change in the contract or the pharmacy benefits manager for that contract; and
b. the new contract, or the contract under the new pharmacy benefits manager, as applicable, provides coverage for that class of drugs.
2. Notwithstanding any other law or regulation to the contrary, the School Employees’ Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall not deny coverage for a maintenance medication prescribed by a covered person’s physician for the covered person’s chronic condition because of a change in the covered person’s pharmaceutical benefits that results solely from a change in the contract or the pharmacy benefits manager for that contract if:
a. the covered person was taking the medication prior to the date of the change in the contract or the pharmacy benefits manager for that contract; and
b. the new contract, or the contract under the new pharmacy benefits manager, as applicable, provides coverage for that class of drugs.
3. Notwithstanding the provisions of any other law or regulation to the contrary, any contract between a carrier and the Division of Medical Assistance and Health Services in the Department of Human Services that provides benefits to persons who are eligible for Medicaid under P.L.1968, c.413 (C.30:4D-1 et seq.) shall not deny coverage for a maintenance medication prescribed by a covered person’s physician for the covered person’s chronic condition because of a change in the covered person’s pharmaceutical benefits that results solely from a change in the contract or the pharmacy benefits manager for that contract if:
a. the covered person was taking the medication prior to the date of the change in the contract or the pharmacy benefits manager for that contract; and
b. the new contract, or the contract under the new pharmacy benefits manager, as applicable, provides coverage for that class of drugs.
4. This act shall take effect on the first day of the seventh month next following the date of enactment and shall apply to contracts issued or renewed on or after the effective date.