New Jersey Assembly Bill A2937

New Jersey 2024-2025 Regular Session

• Introduced: 1/9/24
• Refer: 1/9/24

Caption

Requires health insurers, SHBP, and SEHBP to provide coverage for certain drug regimens for treatment of AIDS or HIV under certain circumstances.

Impact

The bill stipulates that coverage should be provided for both single tablet and multitablet drug regimens, contingent on their clinical effectiveness and adherence rates. In cases where a multitablet regimen is just as effective or superior to a single tablet approach, insurers are required to cover the multitablet regimen following a review by qualified healthcare providers. Furthermore, insurers utilizing a prior authorization process must finalize their approval within 14 days, thus reducing delays that can adversely affect patient treatment plans.

Summary

Assembly Bill A2937 mandates that various health insurers in New Jersey, including the State Health Benefits Program (SHBP) and the School Employees' Health Benefits Program (SEHBP), provide specified coverage for antiretroviral drug regimens designed to treat HIV and AIDS. The legislation aims to ensure patients have access to necessary treatment options, particularly combination therapies that promote better adherence compared to single tablet regimens. This requirement addresses a critical healthcare need, as antiretroviral treatments are essential for managing these chronic conditions effectively.

Contention

Potential points of contention regarding A2937 may arise related to the implications for health insurers and their operational practices. Insurers might raise concerns about the financial impact of mandatory coverage, especially if it leads to increased costs associated with more complex treatment protocols. Additionally, there might be discussions on the sufficiency of the 14-day period for prior authorization, as some stakeholders may feel it is either too lenient or too strict, depending on the urgency of treatment needs.