STATE OF NEW JERSEY
222nd LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION
Sponsored by:
Assemblywoman LINDA S. CARTER
District 22 (Somerset and Union)
Assemblyman MICHAEL VENEZIA
District 34 (Essex)
Assemblywoman VERLINA REYNOLDS-JACKSON
District 15 (Hunterdon and Mercer)
Co-Sponsored by:
Assemblywoman Speight
SYNOPSIS
Requires NJ FamilyCare to reimburse inpatient providers for long-acting injectable antipsychotic drugs at outpatient reimbursement rate.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning NJ FamilyCare reimbursement of long-acting injectable antipsychotic drugs and supplementing Title 30 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Notwithstanding any law, rule, or regulation to the contrary, reimbursement under NJ FamilyCare, whether under the fee-for service or managed care delivery system, for long-acting injectable antipsychotic drugs administered in an inpatient setting shall be :
(1) separate and distinct from any reimbursement issued to an inpatient provider based on a Diagnostic Related Group reimbursement system; and
(2) at a rate equal to the NJ FamilyCare reimbursement rate of the identical long-acting injectable antipsychotic drug when administered in an outpatient setting.
b. The provisions of this section shall not be construed to alter any coverage requirements for long-acting injectable antipsychotic drugs under NJ FamilyCare, when administered in an inpatient setting.
c. As used in this section:
“Diagnostic Related Group reimbursement system” means an inpatient provider payment system that classifies patients into groups based on the patient’s principal procedure, diagnosis, or other significant characteristics to determine the provider’s reimbursement payment.
“Long-acting injectable antipsychotic drugs” mean medications approved by the United States Food and Drug Administration that can treat and manage symptoms of major psychiatric disorders, such as schizophrenia and bipolar disorder, for up to 24 weeks with a single dose.
“NJ FamilyCare” means the program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), which includes the Medicaid program and the Children’s Health Insurance Program.
2. Notwithstanding any law, order, rule, or regulation to the contrary, a pharmacist may administer a long-acting injectable antipsychotic drug to the patient pursuant to a prescription issued by an authorized prescriber, provided that the pharmacist is appropriately educated and qualified to administer the drug, as determined by the New Jersey State Board of Pharmacy, and in accordance with requirements set forth in rules jointly promulgated by the New Jersey State Board of Pharmacy and the State Board of Medical Examiners.
3. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
4. The Commissioner of Human Services, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt rules and regulations necessary to implement the provisions of this act.
5. This act shall take effect on the first day of the fourth month next following the date of enactment, but the Commissioner of Human Services may take such anticipatory administrative action in advance thereof as may be necessary for the implementation of this act.
STATEMENT
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.