Bill Text: NJ A5719 | 2018-2019 | Regular Session | Introduced
Bill Title: Requires health benefits coverage for buprenorphine and buprenorphine/naloxone for pain treatment without step therapy or fail-first protocols.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2019-08-23 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A5719 Detail]
Download: New_Jersey-2018-A5719-Introduced.html
Sponsored by:
Assemblywoman CAROL A. MURPHY
District 7 (Burlington)
SYNOPSIS
Requires health benefits coverage for buprenorphine and buprenorphine/naloxone for pain treatment without step therapy or fail-first protocols.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health benefits coverage for buprenorphine and buprenorphine/naloxone for pain treatment and supplementing various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Notwithstanding any other provision of law to the contrary, a hospital service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of pain. Coverage provided pursuant to this section shall not be subject to step therapy or fail-first protocols.
b. The provisions of this section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
2. a. Notwithstanding any other provision of law to the contrary, a medical service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of pain. Coverage provided pursuant to this section shall not be subject to step therapy or fail-first protocols.
b. The provisions of this section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
3. a. Notwithstanding any other provision of law to the contrary, a health service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of pain. Coverage provided pursuant to this section shall not be subject to step therapy or fail-first protocols.
b. The provisions of this section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.
4. a. Notwithstanding any other provision of law to the contrary, an individual health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of pain. Coverage provided pursuant to this section shall not be subject to step therapy or fail-first protocols.
b. The provisions of this section shall apply to those policies in which the insurer has reserved the right to change the premium.
5. a. Notwithstanding any other provision of law to the contrary, a group health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of pain. Coverage provided pursuant to this section shall not be subject to step therapy or fail-first protocols.
b. The provisions of this section shall apply to those policies in which the insurer has reserved the right to change the premium.
6. a. Notwithstanding any other provision of law to the contrary, an individual health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of pain. Coverage provided pursuant to this section shall not be subject to step therapy or fail-first protocols.
b. The provisions of this section shall apply to all individual health benefits plans in which the carrier has reserved the right to change the premium.
7. a. Notwithstanding any other provision of law to the contrary, a small employer health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of pain. Coverage provided pursuant to this section shall not be subject to step therapy or fail-first protocols.
b. The provisions of this section shall apply to all small employer health benefits plans in which the carrier has reserved the right to change the premium.
8. a. Notwithstanding any other provision of law to the contrary, a health maintenance organization contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of pain. Coverage provided pursuant to this section shall not be subject to step therapy or fail-first protocols.
b. The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the health maintenance organization has reserved the right to change the schedule of charges.
9. 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 or medical expense benefits shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of pain. Coverage provided pursuant to this section shall not be subject to step therapy or fail-first protocols.
10. 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 or medical expense benefits shall provide coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of pain. Coverage provided pursuant to this section shall not be subject to step therapy or fail-first protocols.
11. This act shall take effect on the 90th day next following the date of enactment.
STATEMENT
This bill requires health insurers (health, hospital and medical service corporations, commercial individual and group health insurers; health maintenance organizations, health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs, the State Health Benefits Program, and the School Employees' Health Benefits Program) to provide health benefits coverage for any expenses incurred by a covered person for the prescription and purchase of buprenorphine or buprenorphine/naloxone for the treatment of pain. The bill provides that coverage is not subject to step therapy or fail-first protocols.
Buprenorphine and buprenorphine/naloxone, are medications that are used to treat chronic pain. This bill seeks to make these medications more readily available for people with chronic pain by prohibiting health insurers from applying step therapy or fail-first protocols as a condition for coverage. These protocols are a type of prior authorization which currently may be used by health insurers to require patients to use riskier, more addictive drugs for the treatment of pain, before using buprenorphine and buprenorphine/naloxone, which are less addictive and less likely to be abused by patients.
