New Jersey Assembly Bill A4425

New Jersey 2022-2023 Regular Session

• Introduced: 6/29/22
• Refer: 6/29/22

Caption

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.

Impact

The bill specifically stipulates that if a covered person was taking a medication prior to a change in their health benefits plan or pharmacy benefits manager, coverage for that medication must be maintained, provided that the new plan continue to cover that class of drugs. This provision forges a stronger safety net for chronic patients, ensuring their medical needs are consistently met and preventing any potential gaps in their treatments.

Summary

Assembly Bill A4425 aims to ensure that individuals covered by the State Health Benefits Program (SHBP), School Employees' Health Benefits Program (SEHBP), and Medicaid do not lose coverage for maintenance medications prescribed for chronic conditions when there is a change in their health benefits plan or pharmacy benefits manager. This initiative is a response to the challenges posed by insurance plan transitions that could disrupt essential medication access for covered individuals.

Contention

Despite its intentions, A4425 could ignite discussions regarding the implications for insurance providers and the potential financial impact on state health programs. Critics may argue that requiring insurers to maintain coverage regardless of plan changes could lead to increased costs for the state and for beneficiaries, leading to wider implications in budget allocations for health services. Additionally, the enforcement of such a policy may pose logistical challenges for providers and insurers alike.