New Jersey Assembly Bill A4275

New Jersey 2024-2025 Regular Session

• Introduced: 5/2/24
• Refer: 5/2/24
• Refer: 10/24/24

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

If enacted, A4275 would have significant implications for patients relying on these health programs for their continuous medication needs. It specifically targets situations where a beneficiary might otherwise undergo undue stress and potential health risks due to the abrupt denial of necessary medications during plan transitions. This aligns with broader initiatives to ensure uninterrupted healthcare access and highlights the importance of maintaining treatment consistency for those with chronic illnesses. It could potentially reduce hospital visits and emergency situations stemming from noncompliance with medication regimens.

Summary

Assembly Bill A4275 is aimed at ensuring that individuals who are covered by the State Health Benefits Program (SHBP), School Employees' Health Benefits Program (SEHBP), or Medicaid are not denied coverage for maintenance medications essential for managing chronic conditions. The bill seeks to address a common issue faced by patients whereby a change in their health benefits plan or pharmacy benefits manager could result in the loss of coverage for medications they were previously approved to receive. In its current form, the legislation prohibits such denials when the medication was being taken prior to the change and the new contract continues to cover that class of drugs.

Contention

While the bill appears beneficial for patients, there may be some contention regarding its implementation. Critics might argue concerns about the financial implications on insurance providers or state budgets, given that they would need to adjust policy parameters to comply with the new regulations. Additionally, there could be discussions around whether the bill adequately defines 'maintenance medications' and how this might lead to ambiguity in coverage decisions. Stakeholders and policymakers alike may need to engage in further dialogue to address these potential challenges before the law is finalized.