This bill requires health insurance plans in New Jersey to cover the prescription and purchase of buprenorphine and buprenorphine/naloxone for pain treatment without using step therapy or fail-first protocols. It applies to various types of insurance contracts, including hospital service, medical service, and health service corporation plans, as well as individual and group health insurance policies. The law ensures that people with these insurance plans can access these medications directly without first trying other treatments or meeting additional requirements.
This bill clarifies that testosterone therapy is covered under New Jersey's existing Menopause Coverage Act for women diagnosed with perimenopause or menopause. It requires health insurance plans to provide testosterone therapy to the same extent as other hormonal treatments, even if the FDA has not specifically approved it for these conditions. The legislation also mandates that insurers provide clear information about covered menopause treatments and includes other services like non-hormonal medications, behavioral health care, pelvic floor physical therapy, and bone health treatments. This change directly affects women in New Jersey who use testosterone therapy for menopausal symptoms and the insurance companies that cover their healthcare.
This bill requires New Jersey's Department of Banking and Insurance to conduct a confidential review of how health insurance companies administer hormone replacement therapy coverage under the existing Menopause Coverage Act. The review will examine data on prior authorization and step therapy decisions, as well as whether there has been an overall increase in coverage since the previous law took effect. The department will compile its findings and submit them to the Legislature within six months of the bill becoming effective, after which the review requirement expires.
This bill requires NJ FamilyCare, New Jersey's public health insurance program, to cover prescriptions for healthy foods for certain enrollees. It defines a food prescription as a written order from a healthcare provider for specific foods to treat diet-related health conditions. The legislation amends existing state laws to establish a program that supports small food retailers and pharmacies in stocking and selling fresh produce and other nutritious items at affordable prices. By covering these food prescriptions, the bill aims to improve access to healthy foods for low-income residents, particularly those in areas with limited grocery options. The changes apply to NJ FamilyCare participants who receive healthcare provider prescriptions for specific healthy foods as part of their treatment plans.
This New Jersey bill requires health insurance plans to cover specific breast cancer screening and diagnostic imaging services for women starting at age 18. The law mandates that insurers provide annual mammograms for women 18 and older, along with additional imaging tests like ultrasounds and MRIs when a woman has dense breast tissue, abnormal mammogram results, or other risk factors such as family history or genetic testing. Insurers may still review these additional tests for medical necessity, but the coverage must be provided under the same terms as other medical benefits. The bill applies to all health insurance contracts issued or renewed in the state after the effective date.
This bill allows State employees without collective bargaining representation to enroll in specific negotiated health care plans, such as the CWA Unity DIRECT plan, starting January 1, 2027. It authorizes the State Health Benefits Commission to adjust premium payment obligations for these employees to align with terms from existing collective bargaining agreements. The legislation also clarifies how premium costs are shared for retirees who have 25 years of service credit, ensuring consistency between traditional and managed care plans.
This bill requires pharmacy benefits managers to provide detailed financial reports to health plan sponsors every six months. The reports must include information about drug costs, payments, rebates, and out-of-pocket spending for each medication covered under the plan. The legislation affects pharmacy benefits managers, health plan sponsors, and drug manufacturers by mandating transparency in how these entities handle drug pricing and compensation. Reports must be presented in plain language and machine-readable formats to ensure plan sponsors can easily understand the financial details.
This bill requires New Jersey Medicaid to cover over-the-counter contraceptives and imposes certain requirements on insurers and the State Health Benefits Program regarding existing mandates on health benefits coverage for these products. The legislation directly affects Medicaid recipients, private health insurance plans, and state health programs by ensuring access to contraception without additional cost-sharing. Key provisions include expanding the list of authorized medical services under the Medicaid program and clarifying how contraceptive coverage must be provided within the state's health benefits framework. The bill amends existing statutory law to incorporate these coverage requirements while maintaining compliance with federal Social Security Act regulations.
This bill requires public employers in New Jersey to share the cost of health benefits for retirees who worked for multiple government entities by splitting payments proportionally based on how long each employer employed the retiree. It directly affects state and local government agencies, including law enforcement departments, that currently pay health insurance premiums for retired employees. The key provision mandates that if a retiree qualified for employer-paid health benefits while working for more than one government entity, each former employer must contribute to the premium cost commensurate with their period of employment. The bill also clarifies that this requirement does not apply to employers who have not opted to provide employer-paid health benefits in retirement and does not alter existing collective bargaining agreements.
This bill clarifies that testosterone therapy is covered under New Jersey's existing Menopause Coverage Act, which requires health insurance plans to cover medically necessary treatments for perimenopause and menopause. The legislation specifically ensures that insurance providers cannot deny coverage for testosterone therapy if it is prescribed by a medical provider, even if the federal Food and Drug Administration has not approved it for menopause treatment. It applies to hospital and medical service corporation contracts issued or renewed in New Jersey after the act's effective date. The bill also mandates that insurers provide clear information to subscribers about covered menopause treatments.
