"Ensuring Transparency in Prior Authorization Act."

The "Ensuring Transparency in Prior Authorization Act" requires New Jersey health insurance companies and health plans to publicly disclose their prior authorization requirements, clinical criteria, and approval/denial statistics on their websites in plain language. It mandates that physicians - not administrative staff - make decisions on denied services (adverse determinations) and sets strict time limits for decisions (one business day for routine services, 24 hours for urgent care). The law prohibits prior authorization for emergency services, medications for opioid use disorder, and certain generic medications, while preventing insurers from revoking authorizations within 45 business days of care being provided. This bill directly affects insurers, healthcare providers, and patients by making the prior authorization process more transparent and patient-focused.