ASSEMBLY HEALTH COMMITTEE

STATEMENT TO

ASSEMBLY, No. 1207

with committee amendments

STATE OF NEW JERSEY

DATED:  June 18, 2026

      The Assembly Health Committee reports favorably and with committee amendments Assembly Bill No. 1207.

      As amended by the committee, this bill requires Medicaid coverage for ovulation enhancing drugs and the medical services related to administering such drugs for certain beneficiaries who are experiencing infertility.

      Specifically, the amended bill mandates that Medicaid is to provide coverage for expenses incurred in the provision of medically necessary ovulation enhancing drugs, including the oral versions of clomiphene, bromocriptine, letrozole, tamoxifen, and any other oral ovulation enhancing drug for which the Division of Medical Assistance and Health Services (DMAHS) receives federal financial participation to provide, and the medical services related to prescribing and monitoring the use of such drugs for individuals 21 through 44 years of age who are experiencing infertility, provided that all necessary federal approvals are secured and federal financial participation available is available for State expenditures under the federal Medicaid program.

      As defined under the bill, “infertility” means a condition characterized by the incapacity to conceive, as defined by either:  the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse for individuals 21 through 34 years of age; or the failure to establish a clinical pregnancy after six months of regular, unprotected sexual intercourse for individuals 35 through 44 years of age.

      As amended, the bill mandates that medical services covered under the bill are limited to office visits, hysterosalpingograms, pelvic ultrasounds, and blood testing to diagnose the cause of anovulation or to monitor ovulation induction.  Moreover, coverage of ovulation enhancing drugs and medical services under the bill is limited to three cycles of treatment per lifetime of the beneficiary.

      This bill was pre-filed for introduction in the 2026-2027 session pending technical review.  As reported, the bill includes the changes required by technical review, which has been performed.

COMMITTEE AMENDMENTS:

      The committee amended the bill to stipulate that the drugs covered under bill are to include the oral versions of clomiphene, bromocriptine, letrozole, tamoxifen, and any other oral ovulation enhancing drug for which the DMHAS may receive federal financial participation to provide.

      The committee amended the bill to clarify that the medical services covered under the bill include blood testing to diagnose the cause of anovulation or to monitor ovulation induction.

      The committee amended the bill to mandate that the provision of services under the provisions of the bill is contingent upon the receipt of  all necessary federal approvals and federal financial participation for State expenditures under the federal Medicaid program.

      The committee amended the bill to update the effective date of the bill from the first day of the fourth month following enactment, as originally provided in the bill, to the first day of the twelfth month following enactment.