Requires DOH to maintain emergency stockpile of insulin and authorizes dispensing of emergency supply of insulin to certain patients.

A4324

ASSEMBLY, No. 4324

STATE OF NEW JERSEY

222nd LEGISLATURE

�

INTRODUCED FEBRUARY 19, 2026

Sponsored by:

Assemblywoman� SHANIQUE SPEIGHT

District 29 (Essex and Hudson)

SYNOPSIS

���� Requires DOH to maintain emergency stockpile of
insulin and authorizes dispensing of emergency supply of insulin to certain
patients.�

CURRENT VERSION OF TEXT

���� As introduced.

��

An Act

concerning insulin, supplementing Title 26 and
Title 45 of the Revised Statutes, and amending various parts of the statutory
law.

����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:

���� 1.��� (New section)� a.�
Notwithstanding any law or regulation to the contrary, the Department of Health
shall maintain an adequate emergency stockpile of insulin as shall be necessary
to meet the emergency needs of persons in New Jersey whose insulin supply has
or will run out before the person�s next prescription may be filled.� At a
minimum, the emergency stockpile shall include the 10 most common brands and
types of insulin used by New Jersey residents.� The Commissioner of Health
shall collaborate with the Commissioner of Banking and Insurance to determining
which brands and types of insulin are most commonly used in New Jersey.

���� b.��� In determining the
quantity of insulin the department will need to maintain in order to meet the
requirements of this section, the department shall:

���� (1)�� take into account
prevailing conditions in the State that may affect the need for and
availability of insulin;

���� (2)�� take into account
anticipated surges, over the next 90 days, in the need for emergency supplies
of insulin;

���� (3)�� take into consideration
the current state of the supply chain of insulin in the State, including, but
not limited to, unit cost, recent price increases, overall availability, and
delays in shipping times; and

���� (4)�� utilize any other tool
as the department may designate for use in determining the anticipated need for
emergency insulin.

���� c.���� The Department of
Health shall reevaluate the adequacy of its emergency stockpile of insulin at
least quarterly, and shall acquire such additional supplies of insulin, and
such additional brands and types of insulin, as it determines are necessary to
meet the need for emergency insulin in New Jersey.

���� d.��� (1)� The Department of
Health shall develop a program under which the department will furnish
emergency insulin, at cost, to any person whose insulin supply has or will run
out before the person�s next prescription may be filled.� Subject to the
provisions of paragraph (3) of this subsection, the department may seek
reimbursement for emergency insulin dispensed by the department from the
person�s health benefits plan, if any, or accept cash payment from the person.�

���� (2)�� Except as provided in
paragraph (3) of this subsection, a person shall not obtain more than one
emergency 30-day supply of insulin from the department, or from a pharmacist
pursuant to section 2 of P.L.��� , c.��� (C.������� ) (pending before the
Legislature as this bill), in a 12-month period.

���� (3)�� Notwithstanding the
provisions of paragraph (2) of this subsection, the department may furnish
additional emergency supplies of insulin to a person based on demonstrated
need; provided that nothing in this paragraph shall be construed to require a
person�s health benefits plan carrier, if any, to provide coverage for more
than one emergency 30-day supply of insulin in a 12-month period.

���� (4)�� The department may
establish standards and procedures to verify whether a person�s insulin supply
has or will run out before the person�s next prescription may be filled.

���� e.���� The department shall
develop a sourcing protocol to acquire insulin for its emergency stockpile that
maximizes the cost effectiveness of the program and secures the best available
consumer price for each insulin product.

���� f.���� The department shall
report each emergency 30-day supply of insulin furnished pursuant to subsection
d. of this section to the prescription monitoring database maintained pursuant
to P.L.2007, c.244 (C.45:1-44 et al.) and shall, prior to furnishing an emergency
30-day supply of insulin, review the person�s prescription monitoring
information to determine whether the person was furnished an emergency 30-day
supply of insulin by the department or dispensed an emergency 30-day supply of
insulin by a pharmacy within the preceding 12 months.� To the extent possible,
the information reported by the department concerning an emergency 30-day
supply of insulin furnished by the department shall include the information
required under subsection b. of section 25 of P.L.2007, c.244 (C.45:1-45).

���� 2.��� (New section)� a.
Notwithstanding any other law or regulation to the contrary, a pharmacist may,
no more than once every 12 months, dispense an emergency 30-day supply of
insulin to a person whose insulin supply has or will run out before the
person�s next prescription may be filled, which emergency supply of insulin may
be dispensed pursuant to a standing order issued by a prescriber or pursuant to
the standing order issued pursuant to subsection b. of this section, provided
that:

���� (1)�� the pharmacist has a
record of a previous prescription for insulin for that person, which
prescription was dispensed within the past year;

���� (2)�� the pharmacist is unable
to obtain authorization for an additional supply of insulin from an authorized
prescriber; and

���� (3)�� the amount of insulin
dispensed in the 30-day supply does not exceed the amount that was dispensed
under the most recent prescription for insulin dispensed by the pharmacy to
that person.

���� b.��� The Commissioner of
Health, or, if the commissioner is not a duly licensed physician, the Deputy
Commissioner for Public Health Services, shall issue a standing order
authorizing all licensed pharmacists in the State to dispense emergency 30-day
supplies of insulin pursuant to subsection a. of this section.� The
Commissioner of Health shall provide a copy of the standing order to the Board
of Pharmacy, which shall post a copy of the standing order on the board's
Internet website and transmit a copy of the standing order to all licensed
pharmacists in such a manner as the board deems appropriate.

���� c.���� A pharmacist shall
report each emergency 30-day supply of insulin dispensed pursuant to this
section to the prescription monitoring database maintained pursuant to
P.L.2007, c.244 (C.45:1-44 et al.) and shall, prior to dispensing an emergency
30-day supply of insulin, review the person�s prescription monitoring
information to determine whether the person was dispensed an emergency 30-day
supply of insulin by the Department of Health or by a pharmacy in the preceding
12 months.

���� 3.��� Section 1 of P.L.1995,
c.331 (C.17:48-6n) is amended to read as follows:

���� 1. a. Every individual or
group hospital service corporation contract providing hospital or medical
expense benefits that is delivered, issued, executed or renewed in this State
pursuant to P.L.1938, c.366 (C.17:48-1 et seq.) or approved for issuance or renewal
in this State by the Commissioner of Banking and Insurance on or after the
effective date of this act shall provide benefits to any subscriber or other
person covered thereunder for expenses incurred for the following equipment and
supplies for the treatment of diabetes, if recommended or prescribed by a
physician or nurse practitioner/clinical nurse specialist: blood glucose
monitors and blood glucose monitors for the legally blind; test strips for
glucose monitors and visual reading and urine testing strips; insulin;
injection aids; cartridges for the legally blind; syringes; insulin pumps and
appurtenances thereto; insulin infusion devices; and oral agents for
controlling blood sugar.�
The contract shall additionally provide benefits
to any subscriber or other person covered thereunder for expenses incurred for
one emergency 30-day supply of insulin dispensed pursuant to section 1 or
section 2 of P.L.��� , c.�� (C.������� or C.������� ) (pending before the
Legislature as this bill) in each 12-month period.
� Coverage for the
purchase of a short-acting, intermediate-acting, rapid-acting, long-acting, and
pre-mixed insulin product shall not be subject to any deductible, and no
copayment or coinsurance for the purchase of insulin shall exceed $35 per 30-day
supply.� The provisions of this subsection shall apply to a high-deductible
health plan to the maximum extent permitted by federal law, except if the plan
is used to establish a medical savings account pursuant to section 220 of the
federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a health savings
account pursuant to section 223 of the federal Internal Revenue Code of 1986
(26 U.S.C. s.223).� The provisions of this subsection shall apply to the plan
to the maximum extent that is permitted by federal law and does not disqualify
the account for the deduction allowed under section 220 or 223, as applicable.�
The provisions of this subsection shall apply to a plan that meets the
requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the
maximum extent permitted by federal law.�

���� b.��� Each individual or group
hospital service corporation contract shall also provide benefits for expenses
incurred for diabetes self-management education to ensure that a person with
diabetes is educated as to the proper self-management and treatment of their
diabetic condition, including information on proper diet.� Benefits provided
for self-management education and education relating to diet shall be limited
to visits medically necessary upon the diagnosis of diabetes; upon diagnosis by
a physician or nurse practitioner/clinical nurse specialist of a significant
change in the subscriber's or other covered person's symptoms or conditions
which necessitate changes in that person's self-management; and upon
determination of a physician or nurse practitioner/clinical nurse specialist
that reeducation or refresher education is necessary.� Diabetes self-management
education shall be provided by a dietitian registered by a nationally
recognized professional association of dietitians or a health care professional
recognized as a Certified Diabetes Educator by the American Association of
Diabetes Educators or a registered pharmacist in the State qualified with
regard to management education for diabetes by any institution recognized by
the board of pharmacy of the State of New Jersey.

���� c.���� The benefits required
by this section shall be provided to the same extent as for any other sickness
under the contract.

���� d.��� This section shall apply
to all hospital service corporation contracts in which the hospital service
corporation has reserved the right to change the premium.

���� e.���� The provisions of this
section shall not apply to a health benefits plan subject to the provisions of
P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et
seq.).

���� f.���� The Commissioner of
Banking and Insurance may, in consultation with the Commissioner of Health,
pursuant to the "Administrative Procedure Act," P.L.1968, c.410
(C.52:14B-1 et seq.), promulgate and periodically update a list of additional
diabetes equipment and related supplies that are medically necessary for the
treatment of diabetes and for which benefits shall be provided according to the
provisions of this section.

(cf: P.L.2023, c.105, s.1)

���� 4.��� Section 2 of P.L.1995,
c.331 (C.17:48A-7l) is amended to read as follows:

���� 2. a. Every individual or
group medical service corporation contract providing hospital or medical
expense benefits that is delivered, issued, executed or renewed in this State
pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.) or approved for issuance or renewal
in this State by the Commissioner of Banking and Insurance on or after the
effective date of this act shall provide benefits to any subscriber or other
person covered thereunder for expenses incurred for the following equipment and
supplies for the treatment of diabetes, if recommended or prescribed by a
physician or nurse practitioner/clinical nurse specialist: blood glucose
monitors and blood glucose monitors for the legally blind; test strips for
glucose monitors and visual reading and urine testing strips; insulin;
injection aids; cartridges for the legally blind; syringes; insulin pumps and
appurtenances thereto; insulin infusion devices; and oral agents for
controlling blood sugar.�
The contract shall additionally provide benefits
to any subscriber or other person covered thereunder for expenses incurred for
one emergency 30-day supply of insulin dispensed pursuant to section 1 or
section 2 of P.L.��� , c.�� (C.������� or C.������� ) (pending before the
Legislature as this bill) in each 12-month period.
� Coverage for the
purchase of a short-acting, intermediate-acting, rapid-acting, long-acting, and
pre-mixed insulin product shall not be subject to any deductible, and no
copayment or coinsurance for the purchase of insulin shall exceed $35 per 30-day
supply.� The provisions of this subsection shall apply to a high-deductible
health plan to the maximum extent permitted by federal law, except if the plan
is used to establish a medical savings account pursuant to section 220 of the
federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a health savings
account pursuant to section 223 of the federal Internal Revenue Code of 1986
(26 U.S.C. s.223).� The provisions of this subsection shall apply to the plan
to the maximum extent that is permitted by federal law and does not disqualify
the account for the deduction allowed under section 220 or 223, as applicable.�
The provisions of this subsection shall apply to a plan that meets the
requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the
maximum extent permitted by federal law.

���� b.��� Each individual or group
medical service corporation contract shall also provide benefits for expenses
incurred for diabetes self-management education to ensure that a person with
diabetes is educated as to the proper self-management and treatment of their
diabetic condition, including information on proper diet.� Benefits provided
for self-management education and education relating to diet shall be limited
to visits medically necessary upon the diagnosis of diabetes; upon diagnosis by
a physician or nurse practitioner/clinical nurse specialist of a significant
change in the subscriber's or other covered person's symptoms or conditions
which necessitate changes in that person's self-management; and upon
determination of a physician or nurse practitioner/clinical nurse specialist
that reeducation or refresher education is necessary.� Diabetes self-management
education shall be provided by a dietitian registered by a nationally
recognized professional association of dietitians or a health care professional
recognized as a Certified Diabetes Educator by the American Association of
Diabetes Educators or a registered pharmacist in the State qualified with
regard to management education for diabetes by any institution recognized by
the board of pharmacy of the State of New Jersey.

���� c.���� The benefits required
by this section shall be provided to the same extent as for any other sickness
under the contract.

���� d.��� This section shall apply
to all medical service corporation contracts in which the medical service
corporation has reserved the right to change the premium.

���� e.���� The provisions of this
section shall not apply to a health benefits plan subject to the provisions of
P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et
seq.).

���� f.���� The Commissioner of
Banking and Insurance may, in consultation with the Commissioner of Health,
pursuant to the "Administrative Procedure Act," P.L.1968, c.410
(C.52:14B-1 et seq.), promulgate and periodically update a list of additional
diabetes equipment and related supplies that are medically necessary for the
treatment of diabetes and for which benefits shall be provided according to the
provisions of this section.

(cf: P.L.2023, c.105, s.4)

���� 5.��� Section 3 of P.L.1995,
c.331 (C.17:48E-35.11) is amended to read as follows:

���� 3. a. Every individual or
group health service corporation contract providing hospital or medical expense
benefits that is delivered, issued, executed or renewed in this State pursuant
to P.L.1985, c.236 (C.17:48E-1 et seq.) or approved for issuance or renewal in
this State by the Commissioner of Banking and Insurance on or after the
effective date of this act shall provide benefits to any subscriber or other
person covered thereunder for expenses incurred for the following equipment and
supplies for the treatment of diabetes, if recommended or prescribed by a
physician or nurse practitioner/clinical nurse specialist: blood glucose
monitors and blood glucose monitors for the legally blind; test strips for
glucose monitors and visual reading and urine testing strips; insulin;
injection aids; cartridges for the legally blind; syringes; insulin pumps and
appurtenances thereto; insulin infusion devices; and oral agents for
controlling blood sugar.�
The contract shall additionally provide benefits
to any subscriber or other person covered thereunder for expenses incurred for
one emergency 30-day supply of insulin dispensed pursuant to section 1 or
section 2 of P.L.��� , c.�� (C.������� or C.������� ) (pending before the
Legislature as this bill) in each 12-month period.
� Coverage for the
purchase of a short-acting, intermediate-acting, rapid-acting, long-acting, and
pre-mixed insulin product shall not be subject to any deductible, and no
copayment or coinsurance for the purchase of insulin shall exceed $35 per 30-day
supply.� The provisions of this subsection shall apply to a high-deductible
health plan to the maximum extent permitted by federal law, except if the plan
is used to establish a medical savings account pursuant section 220 of the
federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a health savings
account pursuant to section 223 of the federal Internal Revenue Code of 1986
(26 U.S.C. s.223).� The provisions of this subsection shall apply to the plan
to the maximum extent that is permitted by federal law and does not disqualify
the account for the deduction allowed under section 220 or 223, as applicable.�
The provisions of this subsection shall apply to a plan that meets the
requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the
maximum extent permitted by federal law.

���� b.��� Each individual or group
health service corporation contract shall also provide benefits for expenses
incurred for diabetes self-management education to ensure that a person with
diabetes is educated as to the proper self-management and treatment of their
diabetic condition, including information on proper diet.� Benefits provided
for self-management education and education relating to diet shall be limited
to visits medically necessary upon the diagnosis of diabetes; upon the
diagnosis by a physician or nurse practitioner/clinical nurse specialist of a
significant change in the subscriber's or other covered person's symptoms or
conditions which necessitate changes in that person's self-management; and upon
determination of a physician or nurse practitioner/clinical nurse specialist
that reeducation or refresher education is necessary.� Diabetes self-management
education shall be provided by a dietitian registered by a nationally
recognized professional association of dietitians or a health care professional
recognized as a Certified Diabetes Educator by the American Association of
Diabetes Educators or a registered pharmacist in the State qualified with
regard to management education for diabetes by any institution recognized by
the board of pharmacy of the State of New Jersey.

���� c.���� The benefits required
by this section shall be provided to the same extent as for any other sickness
under the contract.

���� d.��� This section shall apply
to all health service corporation contracts in which the health service
corporation has reserved the right to change the premium.

���� e.���� The provisions of this
section shall not apply to a health benefits plan subject to the provisions of
P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et
seq.).

���� f.���� The Commissioner of
Banking and Insurance may, in consultation with the Commissioner of Health,
pursuant to the "Administrative Procedure Act," P.L.1968, c.410
(C.52:14B-1 et seq.), promulgate and periodically update a list of additional
diabetes equipment and related supplies that are medically necessary for the
treatment of diabetes and for which benefits shall be provided according to the
provisions of this section.

(cf: P.L.2023, c.105, s.7)

���� 6.��� Section 4 of P.L.1995,
c.331 (C.17B:26-2.1l) is amended to read as follows:

���� 4. a. Every individual health
insurance policy providing hospital or medical expense benefits that is
delivered, issued, executed or renewed in this State pursuant to Chapter 26 of
Title 17B of the New Jersey Statutes or approved for issuance or renewal in
this State by the Commissioner of Banking and Insurance on or after the
effective date of this act shall provide benefits to any person covered
thereunder for expenses incurred for the following equipment and supplies for
the treatment of diabetes, if recommended or prescribed by a physician or nurse
practitioner/clinical nurse specialist: blood glucose monitors and blood
glucose monitors for the legally blind; test strips for glucose monitors and
visual reading and urine testing strips; insulin; injection aids; cartridges
for the legally blind; syringes; insulin pumps and appurtenances thereto;
insulin infusion devices; and oral agents for controlling blood sugar
.� The
contract shall additionally provide benefits to any subscriber or other person
covered thereunder for expenses incurred for one emergency 30-day supply of
insulin dispensed pursuant to section 1 or section 2 of
P.L. , c. (C. or C. ) (pending
before the Legislature as this bill) in each 12-month period.
� Coverage for
the purchase of a short-acting, intermediate-acting, rapid-acting, long-acting,
and pre-mixed insulin product shall not be subject to any deductible, and no
copayment or coinsurance for the purchase of insulin shall exceed $35 per
30-day supply.� The provisions of this subsection shall apply to a
high-deductible health plan to the maximum extent permitted by federal law,
except if the plan is used to establish a medical savings account pursuant to
section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a
health savings account pursuant to section 223 of the federal Internal Revenue
Code of 1986 (26 U.S.C. s.223).� The provisions of this subsection shall apply
to the plan to the maximum extent that is permitted by federal law and does not
disqualify the account for the deduction allowed under section 220 or 223, as
applicable.� The provisions of this subsection shall apply to a plan that meets
the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to
the maximum extent permitted by federal law.

���� b.��� Each individual health
insurance policy shall also provide benefits for expenses incurred for diabetes
self-management education to ensure that a person with diabetes is educated as
to the proper self-management and treatment of their diabetic condition,
including information on proper diet.� Benefits provided for self-management
education and education relating to diet shall be limited to visits medically
necessary upon the diagnosis of diabetes; upon diagnosis by a physician or
nurse practitioner/clinical nurse specialist of a significant change in the
covered person's symptoms or conditions which necessitate changes in that
person's self-management; and upon determination of a physician or nurse
practitioner/clinical nurse specialist that reeducation or refresher education
is necessary.� Diabetes self-management education shall be provided by a
dietitian registered by a nationally recognized professional association of
dietitians or a health care professional recognized as a Certified Diabetes
Educator by the American Association of Diabetes Educators or a registered
pharmacist in the State qualified with regard to management education for
diabetes by any institution recognized by the board of pharmacy of the State of
New Jersey.

���� c.���� The benefits required
by this section shall be provided to the same extent as for any other sickness
under the policy.

���� d.��� This section shall apply
to all individual health insurance policies in which the insurer has reserved
the right to change the premium.

���� e.���� The provisions of this
section shall not apply to a health benefits plan subject to the provisions of
P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et
seq.).

���� f.���� The Commissioner of
Banking and Insurance may, in consultation with the Commissioner of Health,
pursuant to the "Administrative Procedure Act," P.L.1968, c.410
(C.52:14B-1 et seq.), promulgate and periodically update a list of additional
diabetes equipment and related supplies that are medically necessary for the
treatment of diabetes and for which benefits shall be provided according to the
provisions of this section.

(cf: P.L.2023, c.105, s.10)

���� 7.��� Section 5 of P.L.1995,
c.331 (C.17B:27-46.1m) is amended to read as follows:

���� 5. a. Every group health
insurance policy providing hospital or medical expense benefits that is
delivered, issued, executed or renewed in this State pursuant to Chapter 27 of
Title 17B of the New Jersey Statutes or approved for issuance or renewal in this
State by the Commissioner of Banking and Insurance on or after the effective
date of this act shall provide benefits to any person covered thereunder for
expenses incurred for the following equipment and supplies for the treatment of
diabetes, if recommended or prescribed by a physician or nurse
practitioner/clinical nurse specialist: blood glucose monitors and blood
glucose monitors for the legally blind; test strips for glucose monitors and
visual reading and urine testing strips; insulin; injection aids; cartridges
for the legally blind; syringes; insulin pumps and appurtenances thereto;
insulin infusion devices; and oral agents for controlling blood sugar.�
The
group health policy shall additionally provide benefits to any subscriber or
other person covered thereunder for expenses incurred for one emergency 30-day
supply of insulin dispensed pursuant to section 1 or section 2 of P.L.��� ,
c.�� (C.������� or C.������� ) (pending before the Legislature as this bill) in
each 12-month period.
� Coverage for the purchase of a short-acting,
intermediate-acting, rapid-acting, long-acting, and pre-mixed insulin product
shall not be subject to any deductible, and no copayment or coinsurance for the
purchase of insulin shall exceed $35 per 30-day supply.� The provisions of this
subsection shall apply to a high-deductible health plan to the maximum extent
permitted by federal law, except if the plan is used to establish a medical
savings account pursuant to section 220 of the federal Internal Revenue Code of
1986 (26 U.S.C. s.220) or a health savings account pursuant to section 223 of
the federal Internal Revenue Code of 1986 (26 U.S.C. s.223).� The provisions of
this subsection shall apply to the plan to the maximum extent that is permitted
by federal law and does not disqualify the account for the deduction allowed
under section 220 or 223, as applicable.� The provisions of this subsection
shall apply to a plan that meets the requirements of a catastrophic plan, as
defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal
law.

���� b.��� Each group health
insurance policy shall also provide benefits for expenses incurred for diabetes
self-management education to ensure that a person with diabetes is educated as
to the proper self-management and treatment of their diabetic condition, including
information on proper diet.� Benefits provided for self-management education
and education relating to diet shall be limited to visits medically necessary
upon the diagnosis of diabetes; upon diagnosis by a physician or nurse
practitioner/clinical nurse specialist of a significant change in the covered
person's symptoms or conditions which necessitate changes in that person's
self-management; and upon determination of a physician or nurse
practitioner/clinical nurse specialist that reeducation or refresher education
is necessary.� Diabetes self-management education shall be provided by a
dietitian registered by a nationally recognized professional association of
dietitians or a health care professional recognized as a Certified Diabetes
Educator by the American Association of Diabetes Educators or a registered
pharmacist in the State qualified with regard to management education for
diabetes by any institution recognized by the board of pharmacy of the State of
New Jersey.

���� c.���� The benefits required
by this section shall be provided to the same extent as for any other sickness
under the policy.

���� d.��� This section shall apply
to all group health insurance policies in which the insurer has reserved the
right to change the premium.

���� e.���� The provisions of this
section shall not apply to a health benefits plan subject to the provisions of
P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et
seq.).

���� f.���� The Commissioner of
Banking and Insurance may, in consultation with the Commissioner of Health,
pursuant to the "Administrative Procedure Act," P.L.1968, c.410
(C.52:14B-1 et seq.), promulgate and periodically update a list of additional
diabetes equipment and related supplies that are medically necessary for the
treatment of diabetes and for which benefits shall be provided according to the
provisions of this section.

(cf: P.L.2023, c.105, s.13)

���� 8.��� Section 6 of P.L.1995,
c.331 (C.26:2J-4.11) is amended to read as follows:

���� 6. a. Every contract for
health care services that is delivered, issued, executed or renewed in this
State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) or approved for issuance
or renewal in this State on or after the effective date of this act shall provide
health care services to any enrollee or other person covered thereunder for the
following equipment and supplies for the treatment of diabetes, if recommended
or prescribed by a participating physician or participating nurse
practitioner/clinical nurse specialist:� blood glucose monitors and blood
glucose monitors for the legally blind; test strips for glucose monitors and
visual reading and urine testing strips; insulin; injection aids; cartridges
for the legally blind; syringes; insulin pumps and appurtenances thereto;
insulin infusion devices; and oral agents for controlling blood sugar.�
The
contract shall additionally provide benefits to any subscriber or other person
covered thereunder for expenses incurred for one emergency 30-day supply of insulin
dispensed pursuant to section 1 or section 2 of P.L.��� , c.�� (C.������� or
C.������� ) (pending before the Legislature as this bill) in each 12-month
period.
� Coverage for the purchase of a short-acting, intermediate-acting,
rapid-acting, long-acting, and pre-mixed insulin product shall not be subject
to any deductible, and no copayment or coinsurance for the purchase of insulin
shall exceed $35 per 30-day supply.� The provisions of this subsection shall
apply to a high-deductible health plan to the maximum extent permitted by
federal law, except if the plan is used to establish a medical savings account
pursuant to section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C.
s.220) or a health savings account pursuant to section 223 of the federal
Internal Revenue Code of 1986 (26 U.S.C. s.223).� The provisions of this
subsection shall apply to the plan to the maximum extent that is permitted by
federal law and does not disqualify the account for the deduction allowed under
section 220 or 223, as applicable.� The provisions of this subsection shall
apply to a plan that meets the requirements of a catastrophic plan, as defined
in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.

���� b.��� Each contract shall also
provide health care services for diabetes self-management education to ensure
that a person with diabetes is educated as to the proper self-management and
treatment of their diabetic condition, including information on proper diet.�
Health care services provided for self-management education and education
relating to diet shall be limited to visits medically necessary upon the
diagnosis of diabetes; upon diagnosis by a participating physician or
participating nurse practitioner/clinical nurse specialist of a significant
change in the enrollee's or other covered person's symptoms or conditions which
necessitate changes in that person's self-management; and upon determination of
a participating physician or participating nurse practitioner/clinical nurse
specialist that reeducation or refresher education is necessary.� Diabetes
self-management education shall be provided by a participating dietitian
registered by a nationally recognized professional association of dietitians or
a health care professional recognized as a Certified Diabetes Educator by the
American Association of Diabetes Educators or, pursuant to section 6 of
P.L.1993, c.378 (C.26:2J-4.7), a registered pharmacist in the State qualified
with regard to management education for diabetes by any institution recognized
by the board of pharmacy of the State of New Jersey.

���� c.���� The health care
services required by this section shall be provided to the same extent as for
any other sickness under the contract.

���� d.��� This section shall apply
to all contracts in which the health maintenance organization has reserved the
right to change the schedule of charges.

���� e.���� The provisions of this
section shall not apply to a health benefits plan subject to the provisions of
P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et
seq.).

���� f.���� The Commissioner of
Banking and Insurance may, in consultation with the Commissioner of Health,
pursuant to the "Administrative Procedure Act," P.L.1968, c.410
(C.52:14B-1 et seq.), promulgate and periodically update a list of additional
diabetes equipment and related supplies that are medically necessary for the
treatment of diabetes and for which benefits shall be provided according to the
provisions of this section.

(cf: P.L.2023, c.105, s.16)

���� 9.��� Section 6 of P.L.1968,
c.413 (C.30:4D-6) is amended to read as follows:

���� 6. a. Subject to the
requirements of Title XIX of the federal Social Security Act, the limitations
imposed by this act and by the rules and regulations promulgated pursuant
thereto, the department shall provide medical assistance to qualified
applicants, including authorized services within each of the following
classifications:

���� (1) Inpatient hospital
services

���� (2) Outpatient hospital
services;

���� (3) Other laboratory and X-ray
services;

���� (4) (a). Skilled nursing or
intermediate care facility services;

���� (b) Early and periodic
screening and diagnosis of individuals who are eligible under the program and
are under age 21, to ascertain their physical or mental health status and the
health care, treatment, and other measures to correct or ameliorate defects and
chronic conditions discovered thereby, as may be provided in regulation of the
Secretary of the federal Department of Health and Human Services and approved
by the commissioner;

���� (5) Physician's services
furnished in the office, the patient's home, a hospital, a skilled nursing, or
intermediate care facility or elsewhere.

���� As used in this subsection,
"laboratory and X-ray services" includes HIV drug resistance testing,
including, but not limited to, genotype assays that have been cleared or
approved by the federal Food and Drug Administration, laboratory developed
genotype assays, phenotype assays, and other assays using phenotype prediction
with genotype comparison, for persons diagnosed with HIV infection or AIDS.

���� b.��� Subject to the
limitations imposed by federal law, by this act, and by the rules and
regulations promulgated pursuant thereto, the medical assistance program may be
expanded to include authorized services within each of the following
classifications:

���� (1) Medical care not included
in subsection a.(5) above, or any other type of remedial care recognized under
State law, furnished by licensed practitioners within the scope of their
practice, as defined by State law;

���� (2) Home health care services;

���� (3) Clinic services;

���� (4) Dental services;

���� (5) Physical therapy and
related services;

���� (6) Prescribed drugs,
dentures, and prosthetic devices; and eyeglasses prescribed by a physician
skilled in diseases of the eye or by an optometrist, whichever the individual
may select;

���� (7) Optometric services;

���� (8) Podiatric services;

���� (9) Chiropractic services;

���� (10) Psychological services;

���� (11) Inpatient psychiatric
hospital services for individuals under 21 years of age, or under age 22 if
they are receiving such services immediately before attaining age 21;

���� (12) Other diagnostic,
screening, preventative, and rehabilitative services, and other remedial care;

���� (13) Inpatient hospital
services, nursing facility services, and immediate care facility services for
individuals 65 years of age or over in an institution for mental diseases;

���� (14) Intermediate care
facility services;

���� (15) Transportation services;

���� (16) Services in connection
with the inpatient or outpatient treatment or care of substance use disorder,
when the treatment is prescribed by a physician and provided in a licensed
hospital or in a narcotic and substance use disorder treatment center approved
by the Department of Health pursuant to P.L.1970, c.334 (C.26:2G-21 et. seq.)
and whose staff includes a medical director, and limited those services
eligible for federal financial participation under Title XIX of the federal
Social Security Act;

���� (17) Any other medical care
and any other type of remedial care recognized under State law, specified by
the Secretary of the federal Department of Health and Human Services, and
approved by the commissioner;

���� (18) Comprehensive maternity
care, which may include: the basic number of prenatal and postpartum visits
recommended by the American College of Obstetrics and Gynecology; additional
prenatal and postpartum visits that are medically necessary; necessary laboratory,
nutritional assessment and counseling, health education, personal counseling,
managed care, outreach, and follow-up services; treatment of conditions which
may complicate pregnancy doula care; and physician or certified nurse midwife
delivery services.� For the purposes of this paragraph, "doula" means
a trained professional who provides continuous physical, emotional, and
informational support to a mother before, during, and shortly after childbirth,
to help her to achieve the healthiest, most satisfying experience possible;

���� (19) Comprehensive pediatric
care, which may include: ambulatory, preventive, and primary care health
services.� The preventive services shall include, at a minimum, the basic
number of preventive visits recommended by the American Academy of Pediatrics;

���� (20) Services provided by a
hospice which is participating in the Medicare program established pursuant to
Title XVIII of the Social Security Act, Pub.L.89-97 (42 U.S.C. s.1395 et
seq.).� Hospice services shall be provided subject to approval of the Secretary
of the federal Department of Health and Human Services for federal
reimbursement;

���� (21) Mammograms, subject to
approval of the Secretary of the federal Department of Health and Human
Services for federal reimbursement, including one baseline mammogram for women
who are at least 35 but less than 40 years of age; one mammogram examination
every two years or more frequently, if recommended by a physician, for women
who are at least 40 but less than 50 years of age; and one mammogram
examination every year for women age 50 and over;

���� (22) Upon referral by a
physician, advanced practice nurse, or physician assistant of a person who has
been diagnosed with diabetes, gestational diabetes, or pre-diabetes, in
accordance with standards adopted by the American Diabetes Association:

���� (a) Expenses for diabetes
self-management education or training to ensure that a person with diabetes,
gestational diabetes, or pre-diabetes can optimize metabolic control, prevent
and manage complications, and maximize quality of life.� Diabetes self-management
education shall be provided by an in-State provider who is:

���� (i) a licensed, registered, or
certified health care professional who is certified by the National
Certification Board of Diabetes Educators as a Certified Diabetes Educator, or
certified by the American Association of Diabetes Educators with a Board Certified-Advanced
Diabetes Management credential, including, but not limited to: a physician, an
advanced practice or registered nurse, a physician assistant, a pharmacist, a
chiropractor, a dietitian registered by a nationally recognized professional
association of dietitians, or a nutritionist holding a certified nutritionist
specialist (CNS) credential from the Board for Certification of Nutrition
Specialists; or

���� (ii) an entity meeting the
National Standards for Diabetes Self-Management Education and Support, as
evidenced by a recognition by the American Diabetes Association or
accreditation by the American Association of Diabetes Educators;

���� (b) Expenses for medical
nutrition therapy as an effective component of the person's overall treatment
plan upon a: diagnosis of diabetes, gestational diabetes, or pre-diabetes;
change in the beneficiary's medical condition, treatment, or diagnosis; or determination
of a physician, advanced practice nurse, or physician assistant that
reeducation or refresher education is necessary.� Medical nutrition therapy
shall be provided by an in-State provider who is a dietitian registered by a
nationally-recognized professional association of dietitians, or a nutritionist
holding a certified nutritionist specialist (CNS) credential from the Board for
Certification of Nutrition Specialists, who is familiar with the components of
diabetes medical nutrition therapy;

���� (c) For a person diagnosed
with pre-diabetes, items and services furnished under an in-State diabetes
prevention program that meets the standards of the National Diabetes Prevention
Program, as established by the federal Centers for Disease Control and Prevention;
and

���� (d) Expenses for any medically
appropriate and necessary supplies and equipment recommended or prescribed by a
physician, advanced practice nurse, or physician assistant for the management
and treatment of diabetes, gestational diabetes, or pre-diabetes, including,
but not limited to: equipment and supplies for self-management of blood
glucose; insulin pens; insulin pumps and related supplies; and other insulin
delivery devices;

���� (23) Expenses incurred for the
provision of group prenatal services to a pregnant woman, provided that:

���� (a) the provider of such
services, which shall include, but not be limited to, a federally qualified
health center or a community health center operating in the State:

���� (i) is a site accredited by
the Centering Healthcare Institute, or is a site engaged in an active
implementation contract with the Centering Healthcare institute, that utilizes
the Centering Pregnancy model; and

���� (ii) incorporates the
applicable information outlined in any best practices manual for prenatal and
postpartum maternal care developed by the Department of Health into the
curriculum for each group prenatal visit;

���� (b) each group prenatal care
visit is at least 1.5 hours in duration, with a. minimum of two women and a
maximum of 20 women in participation; and

���� (c) no more than 10 group
prenatal care visits occur per pregnancy.� As used in this paragraph,
"group prenatal care services" means a series of prenatal care visits
provided in a group setting which are based upon the Centering Pregnancy model
developed by the Centering Healthcare Institute and which include health
assessments, social and clinical support, and educational activities;

���� (24) Expenses incurred for the
provision of pasteurized donated human breast milk, which shall include human
milk fortifiers if indicated in a medical order provided by a licensed medical
practitioner, to an infant under the age of six months; provided that the milk
is obtained from a human milk bank that meets quality guidelines established by
the Department of Health and a licensed medical practitioner has issued a
medical order for the infant under at least one of the following circumstances:

���� (a) the infant is medically or
physically unable to receive maternal breast milk or participate in breast
feeding, or the infant's mother is medically or physically unable to produce
maternal breast milk in sufficient quantities or participate in breast feeding
despite optimal lactation support; or

���� (b) the infant meets any of
the following conditions:

���� (i) a body weight below
healthy levels, as determined by the licensed medical practitioner issuing the
medical order for the infant;

���� (ii) the infant has a
congenital or acquired condition that places the infant at a high risk for
development of necrotizing enterocolitis; or

���� (iii) the infant has a
congenital or acquired condition that may benefit from the use of donor breast
milk and human milk fortifiers, as determined by the Department of Health;

���� (25) Comprehensive tobacco
cessation benefits to an individual who is 18 years of age or older, or who is
pregnant.� Coverage shall include: brief and high intensity individual
counseling, brief and high intensity group counseling, and telemedicine as defined
by section 1 of P.L.2017, c.117 (C.45:1-61); all medications approved for
tobacco cessation by the U.S. Food and Drug Administration; and other tobacco
cessation counseling recommended by the Treating Tobacco Use and Dependence
Clinical Practice Guideline issued by the U.S. Public Health Service.�
Notwithstanding the provisions of any other law, rule, or regulation to the
contrary, and except as otherwise provided in this section:

���� (a) Information regarding the
availability of the tobacco cessation services described in this paragraph
shall be provided to all individuals authorized to receive the tobacco
cessation services pursuant to this paragraph at the following times: no later
than 90 days after the effective date of P.L.2019, c.473: upon the
establishment of an individual's eligibility for medical assistance; and upon
the redetermination of an individual's eligibility for medical assistance;

���� (b) The following conditions
shall not be imposed on any tobacco cessation services provided pursuant to
this paragraph: copayments or any other forms of cost-sharing, including
deductibles; counseling requirements for medication; stepped care therapy or
similar restrictions requiring the use of one service prior to another; limits
on the duration of services; or annual or lifetime limits on the amount,
frequency, or cost of services, including, but not limited to, annual or
lifetime limits on the number of covered attempts to quit; and

���� (c) Prior authorization
requirements shall not be imposed on any tobacco cessation services provided
pursuant to this paragraph except in the following circumstances where prior
authorization may be required: for a treatment that exceeds the duration recommended
by the most recently published United States Public Health Service clinical
practice guidelines on treating tobacco use and dependence; or for services
associated with more than two attempts to quit within a 12-month period;
[
and
]

���� (26) Provided that there is
federal financial participation available, benefits for expenses incurred in
conducting a colorectal cancer screening in accordance with United States
Preventive Services Task Force recommendations.� The method and frequency of
screening to be utilized shall be in accordance with the most recent published
recommendations of the United States Preventive Services Task Force and as
determined medically necessary by the covered person's physician, in
consultation with the covered person.

���� No deductible, coinsurance,
copayment, or any other cost-sharing requirement shall be imposed for a
colonoscopy performed following a positive result on a non-colonoscopy,
colorectal cancer screening test recommended by the United States Preventive
Services Task Force
; and

����
(27)� Expenses incurred for
one emergency 30-day supply of insulin dispensed pursuant to section 1 or
section 2 of
P.L. , c. (C. or C. )
(pending before the Legislature as this bill) in each 12-month period
.

���� c.���� Payments for the
foregoing services, goods and supplies furnished pursuant to this act shall be
made to the extent authorized by this act, the rules and regulations
promulgated pursuant thereto and, where applicable, subject to the agreement of
insurance provided for under this act.� The payments shall constitute payment
in full to the provider on behalf of the recipient.� Every provider making a
claim for payment pursuant to this act shall certify in writing on the claim
submitted that no additional amount will be charged to the recipient, the
recipient's family, the recipient's representative or others on the recipient's
behalf for the services, goods, and supplies furnished pursuant to this act.

���� No provider whose claim for
payment pursuant to this act has been denied because the services, goods, or
supplies were determined to be medically unnecessary shall seek reimbursement
form the recipient, his family, his representative or others on his behalf for
such services, goods, and supplies provided pursuant to this act; provided,
however, a provided may seek reimbursement from a recipient for services,
goods, or supplies not authorized by this act, if the recipient elected to
receive the services, goods or supplies with the knowledge that they were not
authorized.

���� d.��� Any individual eligible
for medical assistance (including drugs) may obtain such assistance from any
person qualified to 33 perform the service or services required (including an
organization which provides such services, or arranges for their availability
on a prepayment basis), who undertakes to provide the individual such services.

���� No copayment or other form of
cost-sharing shall be imposed on any individual eligible for medical
assistance, except as mandated by federal law as a condition of federal
financial participation.

���� e.���� Anything in this act to
the contrary notwithstanding, no payments for medical assistance shall be made
under this act with respect to care or services for any individual who:

���� (1) Is an inmate of a public
institution (except as a patient in a medical institution); provided, however,
that an individual who is otherwise eligible may continue to receive services
for the month in which he becomes an inmate, should the commissioner determine
to expand the scope of Medicaid eligibility to include such an individual,
subject to the limitations imposed by federal law and regulations, or

���� (2) Has not attained 65 years
of age and who is a patient in an institution for mental diseases, or

���� (3) Is over 21 years of age
and who is receiving inpatient psychiatric hospital services in a psychiatric
facility; provided, however, that an individual who was receiving such services
immediately prior to attaining age 21 may continue to receive such services
until the individual reaches age 22.� Nothing in this subsection shall prohibit
the commissioner from extending medical assistance to all eligible persons
receiving inpatient psychiatric services; provided that there is federal
financial participation available.

���� f. (1) A third party as
defined in section 3 of P.L.1968, c.413 (C.30:4D-3) shall not consider a
person's eligibility for Medicaid in this or another state when determining the
person's eligibility for enrollment or the provision of benefits by that third
party.

���� (2) In addition, any provision
in a contract of insurance, health benefits plan, or other health care coverage
document, will, trust, agreement, court order, or other instrument which
reduces or excludes coverage or payment for health care-related goods and
services to or for an individual because of that individual's actual or
potential eligibility for or receipt of Medicaid benefits shall be null and
void, and no payments shall be made under this act as a result of any such
provision.

���� (3) Notwithstanding any
provision of law to the contrary, the provisions of paragraph (2) of this
subsection shall not apply to a trust agreement that is established pursuant to
42 U.S.C. s.1396p(d)(4)(A) or (C) to supplement and augment assistance provided
by government entities to a person who is disabled as defined in section
1614(a)(3) of the federal Social Security Act (42 31 U.S.C. s.1382c (a)(3)).

���� g.��� The following services
shall be provided to eligible medically needy individuals as follows:

���� (1) Pregnant women shall be
provided prenatal care and delivery services and postpartum care, including the
services cited in subsections a.(1), (3), and (5) of this section and
subsections b.(1)-(10), (12), (15), and (17) of this section, and nursing facility
services cited in subsection b.(13) of this section.

���� (2) Dependent children shall
be provided with services cited in subsections a.(3) and (5) of this section
and subsections b.(1), (2), (3), (4), (5), (6), (7), (10), (12), (15), and (17)
of this section, and nursing facility services cited in subsection b.(13) of
this section.

���� (3) Individuals who are 65
years of age or older shall be provided with services cited in subsections
a.(3) and (5) of this section and subsections b.(1)-(5), (6) excluding
prescribed drugs, (7), (8), (10), (12), (15), and (17) of this section, and
nursing facility services cited in subsection b.(13) of this section.

���� (4) Individuals who are blind
or disabled shall be provided with services cited in subsections a.(3) and (5)
of this section and subsections b.(1)-(5), (6) excluding prescribed drugs, (7),
(8), (10), 3 (12), (15), and (17) of this section, and nursing facility
services cited in subsection b.(13) of this section.

���� (5) (a) Inpatient hospital
services, subsection a.(1) of this section, shall only be provided to eligible
medically needy individuals, other than pregnant women, if the federal
Department of Health and Human Services discontinues the State's waiver to establish
inpatient hospital reimbursement rates for the Medicare and Medicaid programs
under the authority of section 601(c)(3) of the Social Security Act Amendments
of 1983, Pub.L.98-21 (42 U.S.C. s.1395ww(c)(5)).� Inpatient hospital services
may be extended to other eligible medically needy individuals if the federal
Department of Health and Human Services directs that these services be
included.

���� (b) Outpatient hospital
services, subsection a.(2) of this section, shall only be provided to eligible
medically needy individuals if the federal Department of Health and Human
Services discontinues the State's waiver to establish outpatient hospital reimbursement
rates for the Medicare and Medicaid programs under the authority of section
601(c)(3) of the Social Security Amendments of 1983, Pub.L.98-21 (42 U.S.C.
s.1395ww(c)(5)).� Outpatient hospital services may be extended to all or to
certain medically needy individuals if the federal Department of Health and
Human Services directs that these services be included.� However, the use of
outpatient hospital services shall be limited to clinic services and to
emergency room services for injuries and significant acute medical conditions.

���� (c) The division shall monitor
the use of inpatient and outpatient hospital services by medically needy
persons.

���� h.��� In the case of a
qualified disabled and working individual pursuant to section h6408 of
Pub.L.101-239 (42 U.S.C. s.1396d), the only medical assistance provided under
this act shall be the payment of premiums for Medicare part A under
42 U.S.C. ss.1395i-2 and 1395r.

���� i.���� In the case of a
specified low-income Medicare beneficiary pursuant to 42 U.S.C.
s.1396a(a)10(E)iii, the only medical assistance provided under this act shall
be the payment of premiums for Medicare part B under 42 U.S.C. s.1395r as
provided for in 42 U.S.C. s.1396d(p)(3)(A)(ii).

���� j.���� In the case of a
qualified individual pursuant to 42 U.S.C. s.1396a(aa), the only
medical assistance provided under this act shall be payment for authorized
services provided during the period in which the individual requires treatment
for breast or cervical cancer, in accordance with criteria established by the
commissioner.

���� k.��� In the case of a
qualified individual pursuant to 42 U.S.C. s.1396a(ii), the only
medical assistance provided under this act shall be payment for family planning
services and supplies as described at 42 U.S.C. s.1396d(a)(4)(C), including medical
diagnosis and treatment services that are provided pursuant to a family
planning service in a family planning setting.

(cf: P.L.2023, c.8, s.11)

���� 10.� Section 25 of P.L.2007,
c.244 (C.45:1-45) is amended to read as follows:

���� 25.� Prescription Monitoring
Program; requirements.

���� a.���� There is established
the Prescription Monitoring Program in the Division of Consumer Affairs in the
Department of Law and Public Safety.� The program shall consist of an
electronic system for monitoring controlled dangerous substances that are
dispensed in or into the State by a pharmacist in an outpatient setting.

���� b.��� Each pharmacy permit
holder shall submit, or cause to be submitted, to the division, by electronic
means in a format and at such intervals as are specified by the director,
information about each prescription for a controlled dangerous substance
dispensed by the pharmacy
, and each emergency 30-day supply of insulin
dispensed by the pharmacy pursuant to section 2 of
P.L. , c. (C. ) (pending
before the Legislature as this bill),
that includes:

���� (1)�� The surname, first name,
and date of birth of the patient for whom the medication is intended;

���� (2)�� The street address and
telephone number of the patient;

���� (3)�� The date that the
medication is dispensed;

���� (4)�� The number or
designation identifying the prescription and the National Drug Code of the drug
dispensed;

���� (5)�� The pharmacy permit
number of the dispensing pharmacy;

���� (6)�� The prescribing
practitioner's name and Drug Enforcement Administration registration number;

���� (7)�� The name, strength, and
quantity of the drug dispensed, the number of refills ordered, and whether the
drug was dispensed as a refill or a new prescription;

���� (8)�� The date that the
prescription was issued by the practitioner;

���� (9)�� The source of payment
for the drug dispensed;

���� (10) Identifying information
for any individual, other than the patient for whom the prescription was
written, who picks up a prescription, if the pharmacist has a reasonable belief
that the person picking up the prescription may be seeking a controlled dangerous
substance, in whole or in part, for any reason other than delivering the
substance to the patient for the treatment of an existing medical condition;
and

���� (11) Such other information,
not inconsistent with federal law, regulation, or funding eligibility
requirements, as the director determines necessary.

���� The pharmacy permit holder
shall submit the information to the division with respect to the prescriptions
dispensed during the reporting period not less frequently than every seven
days.�

���� c.���� The division may grant
a waiver of electronic submission to any pharmacy permit holder for good cause,
including financial hardship, as determined by the director.� The waiver shall
state the format in which the pharmacy permit holder shall submit the required
information.

���� d.��� The requirements of this
act shall not apply to:� the direct administration of a controlled dangerous
substance to the body of an ultimate user; or the administration or dispensing
of a controlled dangerous substance that is otherwise exempted as determined by
the Secretary of Health and Human Services pursuant to the "National All
Schedules Prescription Electronic Reporting Act of 2005," Pub.L.109-60.

���� e.���� The provisions of
paragraph (10) of subsection b. of this section shall not take effect until the
director determines that the Prescription Monitoring Program has the technical
capacity to accept the information required by that paragraph.

(cf: P.L.2015, c.74, s.3)

���� 11.� Section 26 of P.L.2007,
c.244 (C.45:1-46) is amended to read as follows:

���� 26.� Access to prescription
information.�

���� a.���� The division shall
maintain procedures to ensure privacy and confidentiality of patients and that
patient information collected, recorded, transmitted, and maintained is not
disclosed, except as permitted in this section, including, but not limited to,
the use of a password-protected system for maintaining this information and
permitting access thereto as authorized under sections 25 through 30 of
P.L.2007, c.244 (C.45:1-45 through C.45:1-50), and a requirement that a person
as listed in subsection h. or i. of this section provide affirmation of the
person's intent to comply with the provisions of sections 25 through 30 of
P.L.2007, c.244 (C.45:1-45 through C.45:1-50) as a condition of accessing the
information.

���� b.��� The prescription
monitoring information submitted to the division shall be confidential and not
be subject to public disclosure under P.L.1963, c.73 (C.47:1A-1 et seq.), or
P.L.2001, c.404 (C.47:1A-5 et al.).

���� c.���� The division shall
review the prescription monitoring information provided by a pharmacy permit
holder pursuant to sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through
C.45:1-50).� The review shall include, but not be limited to:

���� (1)�� a review to identify
whether any person is obtaining a prescription in a manner that may be
indicative of misuse, abuse, or diversion of a controlled dangerous substance.�
The director shall establish guidelines regarding the terms "misuse,"
"abuse," and "diversion" for the purposes of this review.�
When an evaluation of the information indicates that a person may be obtaining
a prescription for the same or a similar controlled dangerous substance from
multiple practitioners or pharmacists during the same time period, the division
may provide prescription monitoring information about the person to
practitioners and pharmacists; and

���� (2)�� a review to identify
whether a violation of law or regulation or a breach of the applicable
standards of practice by any person may have occurred, including, but not
limited to, diversion of a controlled dangerous substance.� If the division
determines that such a violation or breach may have occurred, the division
shall notify the appropriate law enforcement agency or professional licensing
board, and provide the prescription monitoring information required for an
investigation.

���� d.��� (Deleted by amendment,
P.L.2015, c.74)

���� e.���� (Deleted by amendment,
P.L.2015, c.74)

���� f.���� (Deleted by amendment,
P.L.2015, c.74)

���� g.��� (Deleted by amendment,
P.L.2015, c.74)

���� h. (1) A practitioner shall
register to access prescription monitoring information upon initial application
for, or renewal of , the practitioner's CDS registration.

���� (2)
(a)
�������� The
division shall provide to a pharmacist who is employed by a current pharmacy
permit holder online access to prescription monitoring information for the
purpose of providing health care to a current patient or verifying information
with respect to a patient or a prescriber.

����
(b)�� The division shall
provide online access to prescription monitoring information to such staff of
the Department of Health, or to such other persons as may be designated by the
department, for the purpose of determining whether a person was dispensed an emergency
30-day supply of insulin within the preceding 12 months pursuant to section 1
or section 2 of P.L.��� , c.�� (C.������� or C.������� ) (pending before the
Legislature as this bill).

���� (3)�� The division shall
provide to a practitioner who has a current CDS registration online access to
prescription monitoring information for the purpose of providing health care to
a current patient or verifying information with respect to a patient or a prescriber.�
The division shall also grant online access to prescription monitoring
information to as many licensed health care professionals as are authorized by
a practitioner to access that information and for whom the practitioner is
responsible for the use or misuse of that information, subject to a limit on
the number of such health care professionals as deemed appropriate by the
division for that particular type and size of professional practice, in order
to minimize the burden to practitioners to the extent practicable while
protecting the confidentiality of the prescription monitoring information
obtained.� The director shall establish, by regulation, the terms and
conditions under which a practitioner may delegate that authorization,
including procedures for authorization and termination of authorization,
provisions for maintaining confidentiality, and such other matters as the
division may deem appropriate.

���� (4)�� The division shall
provide online access to prescription monitoring information to as many medical
or dental residents as are authorized by a faculty member of a medical or
dental teaching facility to access that information and for whom the
practitioner is responsible for the use or misuse of that information.� The
director shall establish, by regulation, the terms and conditions under which a
faculty member of a medical or dental teaching facility may delegate that
authorization, including procedures for authorization and termination of
authorization, provisions for maintaining confidentiality, provisions regarding
the duration of a medical or dental resident's authorization to access
prescription monitoring information, and such other matters as the division may
deem appropriate.

���� (5) (a) The division shall
provide online access to prescription monitoring information to :

���� (i) as many certified medical
assistants as are authorized by a practitioner to access that information and
for whom the practitioner is responsible for the use or misuse of that
information ;

���� (ii)�� as many medical scribes
working in a hospital's emergency department as are authorized by a
practitioner to access that information and for whom the practitioner is
responsible for the use or misuse of that information; and

���� (iii)� as many licensed
athletic trainers working in a clinical setting as are authorized by a
practitioner to access that information and for whom the practitioner is
responsible for the use or misuse of that information.�

���� (b)�� The director shall
establish, by regulation, the terms and conditions under which a practitioner
may delegate authorization pursuant to subparagraph (a) of this paragraph ,
including procedures for authorization and termination of authorization,
provisions for maintaining confidentiality, provisions regarding the duration
of a certified medical assistant's , medical scribe's, or licensed athletic
trainer's authorization to access prescription monitoring information, and
provisions addressing such other matters as the division may deem appropriate.

���� (6)�� The division shall
provide online access to prescription monitoring information to as many
registered dental assistants as are authorized by a licensed dentist to access
that information and for whom the licensed dentist is responsible for the use
or misuse of that information.� The director shall establish, by regulation,
the terms and conditions under which a licensed dentist may delegate that
authorization, including procedures for authorization and termination of
authorization, provisions for maintaining confidentiality, provisions regarding
the duration of a registered dental assistant's authorization to access
prescription monitoring information, and such other matters as the division may
deem appropriate.

���� (7)�� A person listed in this
subsection, as a condition of accessing prescription monitoring information
pursuant thereto, shall certify that the request is for the purpose of
providing health care to a current patient or verifying information with
respect to a patient or practitioner.� Such certification shall be furnished
through means of an online statement or alternate means authorized by the
director, in a form and manner prescribed by rule or regulation adopted by the
director.� If the information is being accessed by an authorized person using
an electronic system authorized pursuant to subsection q. of this section, the
certification may be furnished through the electronic system.

���� i.���� The division may
provide online access to prescription monitoring information, or may provide
access to prescription monitoring information through any other means deemed
appropriate by the director, to the following persons:

���� (1)�� authorized personnel of
the division or a vendor or contractor responsible for maintaining the
Prescription Monitoring Program;

���� (2)�� authorized personnel of
the division responsible for administration of the provisions of P.L.1970,
c.226 (C.24:21-1 et seq.);

���� (3)�� the State Medical
Examiner, a county medical examiner, a deputy or assistant county medical
examiner, or a qualified designated assistant thereof, who certifies that the
request is for the purpose of investigating a death pursuant to P.L.1967, c.234
(C.52:17B-78 et seq.);

���� (4)�� a controlled dangerous
substance monitoring program in another state with which the division has
established an interoperability agreement, or which participates with the
division in a system that facilitates the secure sharing of information between
states;

���� (5)�� a designated
representative of the State Board of Medical Examiners, New Jersey State Board
of Dentistry, State Board of Nursing, New Jersey State Board of Optometrists,
State Board of Pharmacy, State Board of Veterinary Medical Examiners, or any
other board in this State or another state that regulates the practice of
persons who are authorized to prescribe or dispense controlled dangerous
substances, as applicable, who certifies that the representative is engaged in
a bona fide specific investigation of a designated practitioner or pharmacist
whose professional practice was or is regulated by that board;

���� (6)�� a State, federal, or
municipal law enforcement officer who is acting pursuant to a court order and
certifies that the officer is engaged in a bona fide specific investigation of
a designated practitioner, pharmacist, or patient. A law enforcement agency that
obtains prescription monitoring information shall comply with security
protocols established by the director by regulation;

���� (7)�� a designated
representative of a state Medicaid or other program who certifies that the
representative is engaged in a bona fide investigation of a designated
practitioner, pharmacist, or patient;

���� (8)�� a properly convened
grand jury pursuant to a subpoena properly issued for the records; and

���� (9)�� a licensed mental health
practitioner providing treatment for substance use disorder to patients at a
residential or outpatient substance use disorder treatment center licensed by
the Division of Mental Health and Addiction Services in the Department of Human
Services, who certifies that the request is for the purpose of providing health
care to a current patient or verifying information with respect to a patient or
practitioner, and who furnishes the division with the written consent of the
patient for the mental health practitioner to obtain prescription monitoring
information about the patient.� The director shall establish, by regulation,
the terms and conditions under which a mental health practitioner may request
and receive prescription monitoring information.� Nothing in sections 25
through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50) shall be construed
to require or obligate a mental health practitioner to access or check the
prescription monitoring information in the course of treatment beyond that
which may be required as part of the mental health practitioner's professional
practice.

���� j.���� A person listed in
subsection i. of this section, as a condition of obtaining prescription
monitoring information pursuant thereto, shall certify the reasons for seeking
to obtain that information.� Such certification shall be furnished through
means of an online statement or alternate means authorized by the director, in
a form and manner prescribed by rule or regulation adopted by the director.�

���� k.��� The division shall offer
an online tutorial for those persons listed in subsections h. and i. of this
section, which shall, at a minimum, include:� how to access prescription
monitoring information; the rights of persons who are the subject of this information;
the responsibilities of persons who access this information; a summary of the
other provisions of sections 25 through 30 of P.L.2007, c.244 (C.45:1-45
through C.45:1-50) and the regulations adopted pursuant thereto, regarding the
permitted uses of that information and penalties for violations thereof; and a
summary of the requirements of the federal health privacy rule set forth at 45
CFR Parts 160 and 164 and a hypertext link to the federal Department of Health
and Human Services website for further information about the specific
provisions of the privacy rule.

���� l.���� The division may
request and receive prescription monitoring information from prescription
monitoring programs in other states and may use that information for the
purposes of sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through
C.45:1-50).� When sharing data with programs in another state, the division
shall not be required to obtain a memorandum of understanding unless required
by the other state.

���� m.�� The director may provide
nonidentifying prescription drug monitoring information to public or private
entities for statistical, research, or educational purposes, in accordance with
the provisions of sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through
C.45:1-50).

���� n.��� Nothing shall be
construed to prohibit the division from obtaining unsolicited automated reports
from the program or disseminating such reports to pharmacists, practitioners,
mental health care practitioners, and other licensed health care professionals.

���� o. (1) A current patient of a
practitioner may request from that practitioner that patient's own prescription
monitoring information that has been submitted to the division pursuant to
sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50).� A
parent or legal guardian of a child who is a current patient of a practitioner
may request from that practitioner the child's prescription monitoring
information that has been submitted to the division pursuant to sections 25
through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50).

���� (2)�� Upon receipt of a
request pursuant to paragraph (1) of this subsection, a practitioner or health
care professional authorized by that practitioner may provide the current
patient or parent or legal guardian, as the case may be, with access to or a
copy of the prescription monitoring information pertaining to that patient or
child.

���� (3)�� The division shall
establish a process by which a patient, or the parent or legal guardian of a
child who is a patient, may request a pharmacy permit holder that submitted
prescription monitoring information concerning a prescription for controlled
dangerous substances for that patient or child to the division pursuant to
sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50) to
correct information that the person believes to have been inaccurately entered
into that patient's or child's prescription profile.� Upon confirmation of the
inaccuracy of any such entry into a patient's or child's prescription profile,
the pharmacy permit holder shall be authorized to correct any such inaccuracies
by submitting corrected information to the division pursuant to sections 25
through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50).� The process shall
provide for review by the Board of Pharmacy of any disputed request for
correction, which determination shall be appealable to the director.

���� p.��� The division shall take
steps to ensure that appropriate channels of communication exist to enable any
licensed health care professional, licensed pharmacist, mental health
practitioner, pharmacy permit holder, or other practitioner who has online
access to the Prescription Monitoring Program pursuant to this section to seek
or provide information to the division related to the provisions of this
section.

���� q. (1) The division may make
prescription monitoring information available on electronic systems that
collect and display health information, such as an electronic system that
connects hospital emergency departments for the purpose of transmitting and obtaining
patient health data from multiple sources , or an electronic system that
notifies practitioners of information pertaining to the treatment of overdoses
; provided that the division determines that any such electronic system has
appropriate security protections in place.�

���� (2)�� Practitioners who are
required to access prescription monitoring information pursuant to section 8 of
P.L.2015, c.74 (C.45:1-46.1) may discharge that responsibility by accessing one
or more authorized electronic systems into which the prescription monitoring
information maintained by the division has been integrated.

(cf: P.L.2023, c.177, s.29)

���� 12.� Section 5 of P.L.1961,
c.49 (C.52:14-17.29) is amended to read as follows:

���� 5. �(A) �The contract or
contracts purchased by the commission pursuant to subsection b. of section 4 of
P.L.1961, c.49 (C.52:14-17.28) shall provide separate coverages or policies as
follows:

���� (1)�� Basic benefits which
shall include:

���� (a)�� Hospital benefits,
including outpatient;

���� (b)�� Surgical benefits;

���� (c)�� Inpatient medical
benefits;

���� (d)�� Obstetrical benefits;
and

���� (e)�� Services rendered by an
extended care facility or by a home health agency and for specified medical
care visits by a physician during an eligible period of such services, without
regard to whether the patient has been hospitalized, to the extent and subject
to the conditions and limitations agreed to by the commission and the carrier
or carriers.

���� Basic benefits shall be
substantially equivalent to those available on a group remittance basis to
employees of the State and their dependents under the subscription contracts of
the New Jersey "Blue Cross" and "Blue Shield" Plans. Such
basic benefits shall include benefits for:

���� (i)��� Additional days of
inpatient medical service;

���� (ii)�� Surgery elsewhere than
in a hospital;

���� (iii) X-ray, radioactive
isotope therapy and pathology services;

���� (iv)� Physical therapy
services;

���� (v)�� Radium or radon therapy
services;

and the extended basic benefits
shall be subject to the same conditions and limitations, applicable to such
benefits, as are set forth in "Extended Outpatient Hospital Benefits
Rider," Form 1500, 71(9-66), and in "Extended Benefit Rider" (as
amended), Form MS 7050J(9-66) issued by the New Jersey "Blue Cross"
and "Blue Shield" Plans, respectively, and as the same may be amended
or superseded, subject to filing by the Commissioner of Banking and Insurance;
and

���� (2)�� Major medical expense
benefits which shall provide benefit payments for reasonable and necessary
eligible medical expenses for hospitalization, surgery, medical treatment and
other related services and supplies to the extent they are not covered by basic
benefits. The commission may, by regulation, determine what types of services
and supplies shall be included as "eligible medical services" under
the major medical expense benefits coverage as well as those which shall be
excluded from or limited under such coverage. Benefit payments for major
medical expense benefits shall be equal to a percentage of the reasonable
charges for eligible medical services incurred by a covered employee or an
employee's covered dependent, during a calendar year as exceed a deductible for
such calendar year of $100.00 subject to the maximums hereinafter provided and
to the other terms and conditions authorized by this act. The percentage shall
be 80 percent of the first $2,000.00 of charges for eligible medical services
incurred subsequent to satisfaction of the deductible and 100 percent
thereafter. There shall be a separate deductible for each calendar year for (a)
each enrolled employee and (b) all enrolled dependents of such employee. Not
more than $1,000,000.00 shall be paid for major medical expense benefits with
respect to any one person for the entire period of such person's coverage under
the plan, whether continuous or interrupted except that this maximum may be
reapplied to a covered person in amounts not to exceed $2,000.00 a year.
Maximums of $10,000.00 per calendar year and $20,000.00 for the entire period
of the person's coverage under the plan shall apply to eligible expenses
incurred because of mental illness or functional nervous disorders, and such
may be reapplied to a covered person, except as provided in P.L.1999, c.441
(C.52:14-17.29d et al.). The same provisions shall apply for retired employees
and their dependents. Under the conditions agreed upon by the commission and
the carriers as set forth in the contract, the deductible for a calendar year
may be satisfied in whole or in part by eligible charges incurred during the
last three months of the prior calendar year.

���� Any service determined by
regulation of the commission to be an "eligible medical service"
under the major medical expense benefits coverage which is performed by a duly
licensed practicing psychologist within the lawful scope of psychologist
practice shall be recognized for reimbursement under the same conditions as
would apply were such service performed by a physician.

���� (B)� The contract or contracts
purchased by the commission pursuant to subsection c. of section 4 of P.L.1961,
c.49 (C.52:14-17.28) shall include coverage for services and benefits that are
at a level that is equal to or exceeds the level of services and benefits set
forth in this subsection, provided that such services and benefits shall
include only those that are eligible medical services and not those deemed
experimental, investigative or otherwise not eligible medical services. The
determination of whether services or benefits are eligible medical services
shall be made by the commission consistent with the best interests of the State
and participating employers, employees, and dependents. The following list of
services is not intended to be exclusive or to require that any limits or
exclusions be exceeded.

���� Covered services shall
include:

���� (1)�� Physician services,
including:

���� (a)�� Inpatient services,
including:

���� (i)��� medical care including
consultations;

���� (ii)�� surgical services and
services related thereto; and

���� (iii) obstetrical services
including normal delivery, cesarean section, and abortion.

���� (b)�� Outpatient/out-of-hospital
services, including:

���� (i)��� office visits for
covered services and care;

���� (ii)�� allergy testing and
related diagnostic/therapy services;

���� (iii) dialysis center care;

���� (iv)� maternity care;

���� (v)�� well child care;

���� (vi)� child immunizations/lead
screening;

���� (vii) routine adult physicals
including pap, mammography, and prostate examinations; and

���� (viii) annual routine
obstetrical/gynecological exam.

���� (2)�� Hospital services, both
inpatient and outpatient, including:

���� (a)�� room and board;

���� (b)�� intensive care and other
required levels of care;

���� (c)�� semi-private room;

���� (d)�� therapy and diagnostic
services;

���� (e)�� surgical services or
facilities and treatment related thereto;

���� (f)�� nursing care;

���� (g)�� necessary supplies,
medicines, and equipment for care; and

���� (h)�� maternity care and
related services.

���� (3)�� Other facility and
services, including:

���� (a)�� approved treatment
centers for medical emergency/accidental injury;

���� (b)�� approved surgical
center;

���� (c)�� hospice;

���� (d)�� chemotherapy;

���� (e)�� diagnostic x-ray and lab
tests;

���� (f)�� ambulance;

���� (g)�� durable medical
equipment;

���� (h)�� prosthetic devices;

���� (i)��� foot orthotics;

���� (j)��� diabetic supplies and
education
, including expenses incurred for one emergency 30-day supply of
insulin dispensed pursuant to section 1 or section 2 of P.L.��� , c.��
(C.������� or C.������� ) (pending before the Legislature as this bill) in each
12-month period
; and

���� (k)�� oxygen and oxygen
administration.

���� (4)�� All services for which
coverage is required pursuant to P.L.1961, c.49 (C.52:14-17.25 et seq.), as
amended and supplemented. Benefits under the contract or contracts purchased as
authorized by the State Health Benefits Program shall include those for mental
health services subject to limits and exclusions consistent with the provisions
of the New Jersey State Health Benefits Program Act.

���� (C)� The contract or contracts
purchased by the commission pursuant to subsection c. of section 4 of P.L.1961,
c.49 (C.52:14-17.28) shall include the following provisions regarding
reimbursements and payments:

���� (1)�� In the successor plan,
the co-payment for doctor's office visits shall be $10 per visit with a maximum
out-of-pocket of $400 per individual and $1,000 per family for in-network
services for each calendar year. The out-of-network deductible shall be $100 per
individual and $250 per family for each calendar year, and the participant
shall receive reimbursement for out-of-network charges at the rate of 80 percent
of reasonable and customary charges, provided that the out-of-pocket maximum
shall not exceed $2,000 per individual and $5,000 per family for each calendar
year.

���� (2)�� In the State managed
care plan that is required to be included in a contract entered into pursuant
to subsection c. of section 4 of P.L.1961, c.49 (C.52:14-17.28), the co-payment
for doctor's office visits shall be $15 per visit. The participant shall receive
reimbursement for out-of-network charges at the rate of 70% of reasonable and
customary charges. The in-network and out-of-network limits, exclusions,
maximums, and deductibles shall be substantially equivalent to those in the NJ
PLUS plan in effect on June 30, 2007, with adjustments to that plan pursuant to
a binding collective negotiations agreement or pursuant to action by the
commission, in its sole discretion, to apply such adjustments to State
employees for whom there is no majority representative for collective
negotiations purposes.

���� (3)�� "Reasonable and
customary charges" means charges based upon the 90th percentile of the
usual, customary, and reasonable (UCR) fee schedule determined by the Health
Insurance Association of America or a similar nationally recognized database of
prevailing health care charges.

���� (D)� Benefits under the
contract or contracts purchased as authorized by this act may be subject to
such limitations, exclusions, or waiting periods as the commission finds to be
necessary or desirable to avoid inequity, unnecessary utilization, duplication
of services or benefits otherwise available, including coverage afforded under
the laws of the United States, such as the federal Medicare program, or for
other reasons.

���� Benefits under the contract or
contracts purchased as authorized by this act shall include those for the treatment
of alcohol use disorder where such treatment is prescribed by a physician and
shall also include treatment while confined in or as an outpatient of a
licensed hospital or residential treatment program which meets minimum
standards of care equivalent to those prescribed by the Joint Commission on
Hospital Accreditation. No benefits shall be provided beyond those stipulated
in the contracts held by the State Health Benefits Commission.

���� (E)� The rates charged for any
contract purchased under the authority of this act shall reasonably and
equitably reflect the cost of the benefits provided based on principles which
in the judgment of the commission are actuarially sound. The rates charged shall
be determined by the carrier on accepted group rating principles with due
regard to the experience, both past and contemplated, under the contract. The
commission shall have the right to particularize subgroups for experience
purposes and rates. No increase in rates shall be retroactive.

���� (F)�� The initial term of any
contract purchased by the commission under the authority of this act shall be
for such period to which the commission and the carrier may agree, but
permission may be made for automatic renewal in the absence of notice of
termination by the commission. Subsequent terms for which any contract may be
renewed as herein provided shall each be limited to a period not to exceed one
year.

���� (G)� A contract purchased by
the commission pursuant to subsection b. of section 4 of P.L.1961, c.49
(C.52:14-17.28) shall contain a provision that if basic benefits or major
medical expense benefits of an employee or of an eligible dependent under the
contract, after having been in effect for at least one month in the case of
basic benefits or at least three months in the case of major medical expense
benefits, is terminated, other than by voluntary cancellation of enrollment,
there shall be a 31-day period following the effective date of termination
during which such employee or dependent may exercise the option to convert,
without evidence of good health, to converted coverage issued by the carriers
on a direct payment basis. Such converted coverage shall include benefits of
the type classified as "basic benefits" or "major medical
expense benefits" in subsection (A) hereof and shall be equivalent to the
benefits which had been provided when the person was covered as an employee.
The provision shall further stipulate that the employee or dependent exercising
the option to convert shall pay the full periodic charges for the converted
coverage which shall be subject to such terms and conditions as are normally
prescribed by the carrier for this type of coverage.

���� (H)� The commission may
purchase a contract or contracts to provide drug prescription and other health
care benefits or authorize the purchase of a contract or contracts to provide
drug prescription and other health care benefits as may be required to implement
a duly executed collective negotiations agreement or as may be required to
implement a determination by a public employer to provide such benefit or
benefits to employees not included in collective negotiations units.

���� (I)�� The commission shall
take action as necessary, in cooperation with the School Employees' Health
Benefits Commission established pursuant to section 33 of P.L.2007, c.103
(C.52:14-17.46.3), to effectuate the purposes of the School Employees' Health
Benefits Program Act as provided in sections 31 through 41 of P.L.2007, c.103
(C.52:14-17.46.1 through C.52:14-17.46.11) and to enable the School Employees'
Health Benefits Commission to begin providing coverage to participants pursuant
to the School Employees' Health Benefits Program Act as of July 1, 2008.

���� (J)�� Beginning January 1,
2012, the State Health Benefits Plan Design Committee shall provide to
employees the option to select one of at least three levels of coverage each
for family, individual, individual and spouse, and individual and dependent, or
equivalent categories, for each plan offered by the program differentiated by
out of pocket costs to employees including co-payments and deductibles.�
Notwithstanding any other provision of law to the contrary, the committee shall
have the sole discretion to set the amounts for maximums, co-pays, deductibles,
and other such participant costs for all plans in the program.� The committee
shall also provide for a high deductible health plan that conforms with
Internal Revenue Code Section 223.�

���� There shall be appropriated
annually for each State fiscal year, through the annual appropriations act,
such amounts as shall be necessary as funding by the State as an employer, or
as otherwise required, with regard to employees or retirees who have enrolled
in a high deductible health plan that conforms with Internal Revenue Code
Section 223.

(cf: P.L.2023, c.177, s.139)

���� 13.� Section 36 of P.L.2007,
c.103 (C.52:14-17.46.6) is amended to read as follows:

���� 36. �a. �Notwithstanding the
provisions of any other law to the contrary, the commission shall not enter
into a contract under the School Employees' Health Benefits Program Act,
sections 31 through 41 of P.L.2007, c.103 (C.52:14-17.46.1 through
C.52:14-17.46.11), for the benefits provided pursuant to the act, unless the
level of benefits provided under the contract entered into is equal to or
exceeds the level of benefits provided in this section, or as modified pursuant
to section 40 of that act (C.52:14-17.46.10). Only benefits for medically
necessary services that are not deemed experimental, investigative or otherwise
not eligible medical services shall be provided. The determination that
services are not "eligible medical services" shall be made by the
commission consistent with the best interests of the State, participating
employers and those persons covered hereunder. Benefits for services provided
pursuant to the School Employees' Health Benefits Act shall be subject to
limits or exclusions consistent with those that apply to benefits provided
pursuant to the New Jersey State Health Benefits Program Act. The services
provided pursuant to this section shall include all services, subject to
applicable limits and exclusions, provided through the State Health Benefits
Program as of July 1, 2007. The list of services in subsection b. of this
section is not intended to be exclusive or to require that any limits or
exclusions be exceeded.

���� b.��� The services covered
hereunder by the School Employees' Health Benefits Program shall include:

���� (1)�� Physician services,
including:

���� (a)�� Inpatient services,
including:

���� (i)��� medical care including
consultations;

���� (ii)�� surgical services and
services related thereto; and

���� (iii)� obstetrical services
including normal delivery, cesarean section, and abortion.

���� (b)�� Outpatient/out-of-hospital
services, including:

���� (i)��� office visits for
covered services and care;

���� (ii)�� allergy testing and
related diagnostic/therapy services;

���� (iii) dialysis center care;

���� (iv)� maternity care;

���� (v)�� well child care;

���� (vi)� child immunizations/lead
screening;

���� (vii) routine adult physicals
including pap, mammography, and prostate examinations; and

���� (viii) annual routine
obstetrical/gynecological exam.

���� (2)�� Hospital services, both
inpatient and outpatient, including:

���� (a)�� room and board;

���� (b)�� intensive care and other
required levels of care;

���� (c)�� semi-private room;

���� (d)�� therapy and diagnostic
services;

���� (e)�� surgical services or
facilities and treatment related thereto;

���� (f)�� nursing care;

���� (g)�� necessary supplies,
medicines, and equipment for care; and

���� (h)�� maternity care and
related services.

���� (3)�� Other facility and
services, including:

���� (a)�� approved treatment
centers for medical emergency/accidental injury;

���� (b)�� approved surgical
center;

���� (c)�� hospice;

���� (d)�� chemotherapy;

���� (e)�� diagnostic x-ray and lab
tests;

���� (f)�� ambulance;

���� (g)�� durable medical
equipment;

���� (h)�� prosthetic devices;

���� (i)��� foot orthotics;

���� (j)��� diabetic supplies and
education
, including expenses incurred for one emergency 30-day supply of
insulin dispensed pursuant to section 1 or section 2 of P.L.��� , c.��
(C.������� or C.������� ) (pending before the Legislature as this bill) in each
12-month period
; and

���� (k)�� oxygen and oxygen
administration.

���� c.���� Benefits under the
contract or contracts purchased as authorized by the School Employees' Health
Benefits Program Act shall include those for the treatment of alcohol use
disorder where such treatment is prescribed by a physician and shall also
include treatment while confined in or as an outpatient of a licensed hospital
or residential treatment program which meets minimum standards of care
equivalent to those prescribed by the Joint Commission on Hospital
Accreditation. No benefits shall be provided beyond those stipulated in the
contracts held by the School Employees' Health Benefits Commission.

���� d.��� Benefits under the
contract or contracts purchased as authorized by the School Employees' Health
Benefits Program Act shall include those for mental health services subject to
limits and exclusions consistent with those that apply to benefits for such services
pursuant to the New Jersey State Health Benefits Program Act. Coverage for
biologically-based mental illness, as defined in section 1 of P.L.1999, c.441
(C.52:14-17.29d), shall be provided in accordance with section 2 of P.L.1999,
c.441 (C.52:14-17.29e).

���� e.���� Coverage provided under
the School Employees' Health Benefits Program Act shall include coverage for
all services for which coverage is mandated in the State Health Benefits
Program pursuant to P.L.1961, c.49 (C.52:14-17.25 et seq.).

���� f. �(1) �As used in this
subsection:

���� (a)�� "brand name"
means the proprietary or trade name assigned to a drug product by the
manufacturer or distributor of the drug product.

���� (b)�� "carrier"
means an insurance company, hospital, medical, or health service corporation,
preferred provider organization, or health maintenance organization under
agreement or contract with the commission to administer the School Employee
Prescription Drug Plan.

���� (c)�� "School Employee
Prescription Drug Plan" means the plan for providing payment for eligible
prescription drug expenses of members of the School Employees' Health Benefits
Program and their eligible dependents.

���� (d)�� "generic drug
products" means prescription drug products and insulin approved and
designated by the United States Food and Drug Administration as therapeutic
equivalents for reference listed drug products. The term includes drug products
listed in the New Jersey Generic Formulary by the Drug Utilization Review
Council pursuant to P.L.1977, c.240 (C.24:6E-1 et al.).

���� (e)�� "mail-order
pharmacy" means the mail order program available through the carrier.

���� (f)�� "preferred
brands" means brand name prescription drug products and insulin determined
by the carrier to be a more cost effective alternative for prescription drug
products and insulin with comparable therapeutic efficacy within a therapeutic
class, as defined or recognized in the United States Pharmacopeia or the
American Hospital Formulary Service Drug Information, or by the American
Society of Health Systems Pharmacists. A drug product for which there is no
other therapeutically equivalent drug product shall be a preferred brand.
Determinations of preferred brands by the carrier shall be subject to review
and modification by the commission.

���� (g)�� "retail
pharmacy" means a pharmacy, drug store or other retail establishment in
this State at which prescription drugs are dispensed by a registered pharmacist
under the laws of this State, or a pharmacy, drug store or other retail
establishment in another state at which prescription drug products are
dispensed by a registered pharmacist under the laws of that state if expenses
for prescription drug products dispensed at the pharmacy, drug store, or other
retail establishment are eligible for payment under the School Employee
Prescription Drug Plan.

���� (h)�� "other brands"
means prescription drug products which are not preferred brands or generic drug
products. A new drug product approved by the United States Food and Drug
Administration which is not a generic drug product shall be included in this
category until the carrier makes a determination concerning inclusion of the
drug product in the list of preferred brands.

���� (2) (a) Employers that
participate in the School Employees' Health Benefits Program may offer to their
employees and eligible dependents:

���� (i)��� enrollment in the
School Employee Prescription Drug Plan, or

���� (ii)�� enrollment in another
free-standing prescription drug plan, or

���� (iii) election of prescription
drug coverage under their health care coverage through the School Employees'
Health Benefits Program plan or as otherwise determined by the commission.

���� (b)�� A co-payment shall be
required for each prescription drug expense if the employer chooses to
participate in the School Employee Prescription Drug Plan. The initial amounts
of the co-payments shall be the same as those in effect on July 1, 2007 for the
employee prescription drug plan offered through the State Health Benefits
Program.

���� (c)�� If the employer elects
to offer a free-standing prescription drug plan, the employee's share of the
cost for this prescription drug plan may be determined by means of a binding
collective negotiations agreement, including any agreements in force at the time
the employer commences participation in the School Employees' Health Benefits
Program.

���� (d)�� If an employee declines
the employer's offering of a free-standing prescription drug plan, no
reimbursement for prescription drugs shall be provided under the health care
coverage through the School Employees' Health Benefits Program plan in which
the employee is enrolled.

���� (e)�� Prescription drug
classifications that are not eligible for coverage under the employer's
prescription drug plan shall also not be eligible for coverage under the health
care coverage through the School Employees' Health Benefits Program plan except
as federally or State mandated.

���� (f)�� If the employer elects
to not offer a free-standing prescription drug plan, then the employer shall
offer prescription drug coverage under the health care coverage through the
School Employees' Health Benefits Program plan or as determined by the commission.
Any plan that has in-network and out-of-network coverage shall cover
prescription drugs at 90 percent in-network and at the out-of-network rate
applicable to health care coverage in the plan. The out-of-pocket amounts paid
towards prescription drugs shall be combined with out-of-pocket medical
payments to reach all out-of-pocket maximums.

���� (g)�� Health care coverages
through the School Employees' Health Benefits Program that only have in-network
benefits shall include a prescription card with co-payment amounts the same as
those in effect on July 1, 2007 for such coverages offered through the State
Health Benefits Program.

���� (h)�� In the fifth year
following the initial appointment of all of its members, the commission shall,
as part of the fifth year audit and review undertaken pursuant to section 40 of
that act (C.52:14-17.46.10), review the prescription drug program established
in this subsection and may make changes in the program pursuant to the terms of
section 40 by majority vote of the full authorized membership of the
commission.

���� g.��� Beginning January 1,
2012, the School Employees' Health Benefits Plan Design Committee shall provide
to employees the option �to �select �one �of �at �least �three� levels of
coverage each for family, individual, individual and spouse, and individual and
dependent, or equivalent categories, for each plan offered by the program
differentiated by out of pocket costs to employees including co-payments and
deductibles.� Notwithstanding any other provision of law to the contrary, the
committee shall have the sole discretion to set the amounts for maximums,
co-pays, deductibles, and other such participant costs for all plans in the
program.� The committee shall also provide for a high deductible health plan
that conforms with Internal Revenue Code Section 223.

���� There shall be appropriated
annually for each State fiscal year, through the annual appropriations act,
such amounts as shall be necessary as funding by the State with regard to
retirees who have enrolled in a high deductible health plan that conforms with
Internal Revenue Code Section 223.�

(cf: P.L.2023, c.177, s.141)

���� 14.� (New section)� The
Commissioner of Human Services shall apply for such State plan amendments or
waivers as may be necessary to implement the provisions of this act and to
secure federal financial participation for State Medicaid expenditures under
the federal Medicaid program.

���� 15.� (New section) The
Commissioner of Health, the Commissioner of Banking and Insurance, the Board of
Medical Examiners, the Board of Nursing, and the Board of Pharmacy shall each
adopt rules and regulations, pursuant to the �Administrative Procedure Act,� P.L.1968,
c.410 (C.52:14B-1 et seq.), as shall be necessary to implement the provisions
of this bill.

���� 16.� This act shall take
effect on the first day of the third month next following enactment, except
that section 1 of this act shall take effect 180 days after enactment, and the
provisions of sections 3 through 8 and sections 13 and 14 of this act shall apply
to contracts and policies delivered, issued, executed, or renewed, or approved
for issuance or renewal, on or after the effective date of this act.

STATEMENT

���� This bill establishes
requirements for patients to access emergency supplies of insulin and provides
for insurance coverage of emergency insulin.

���� Specifically, the bill
requires the Department of Health (DOH) to maintain an adequate emergency
stockpile of insulin as is necessary to meet the emergency needs of people in
New Jersey whose insulin supply has or will run out before the person�s next prescription
may be filled.� At a minimum, the emergency stockpile is include the 10 most
common brands and types of insulin used by New Jersey residents.� The DOH will
be required to collaborate with the Commissioner of Banking and Insurance to
determine which brands and types of insulin are most commonly used in New
Jersey.

���� In determining the quantity of
insulin the DOH will need to maintain under the bill, the DOH will be required
to take into account prevailing conditions in the State that may affect the
need for and availability of insulin; take into account anticipated surges,
over the next 90 days, in the need for emergency supplies of insulin; take into
consideration the current state of the supply chain of insulin in the State,
including, but not limited to, unit cost, recent price increases, overall
availability, and delays in shipping times; and utilize any other tool as the
DOH designates for use in determining the anticipated need for emergency
insulin.� The DOH will be required to reevaluate the adequacy of its emergency stockpile
of insulin at least quarterly and acquire such additional supplies of insulin,
and such additional brands and types of insulin, as it determines are necessary
to meet the need for emergency insulin in New Jersey.

���� The DOH will be required to
develop a sourcing protocol to acquire insulin for its emergency stockpile that
maximizes the cost effectiveness of the program and secures the best available
consumer price for each insulin product.

���� The DOH will be required to
develop a program under which the DOH will furnish emergency insulin, at cost,
to individuals whose insulin supply has or will run out before the person�s
next prescription may be filled.� The DOH will be authorized to seek reimbursement
for the emergency insulin from the person�s health benefits plan, if any, or
accept cash payment from the person.� The department may establish standards
and procedures to verify whether a person�s insulin supply has or will run out
before the person�s next prescription may be filled.

���� The bill additionally
authorizes pharmacists to dispense an emergency 30-day supply of insulin once
every 12 months, which emergency supply of insulin may be dispensed pursuant to
a standing order issued by a prescriber or pursuant to the standing order issued
by the DOH under the bill.� In order to dispense emergency insulin to a person
under the bill, the pharmacist will need to:� have a record of a previous
prescription for insulin for that person, which prescription was dispensed
within the past year; have been unable to obtain authorization for an
additional supply of insulin from an authorized prescriber; and ensure the
amount of insulin dispensed in the emergency 30-day supply does not exceed the
amount that was dispensed under the most recent prescription for insulin
dispensed by the pharmacy to that person.

���� The Commissioner of Health,
or, if the commissioner is not a duly licensed physician, the Deputy
Commissioner for Public Health Services, will be required to issue a standing
order authorizing all licensed pharmacists in the State to dispense emergency insulin
under the bill.� The Commissioner of Health is to provide a copy of the
standing order to the Board of Pharmacy, which will post a copy of the standing
order on the board's Internet website and transmit a copy of the standing order
to all licensed pharmacists in such a manner as the board deems appropriate.

���� In general, individuals may
not receive more than one emergency 30-day supply of insulin in a given
12-month period, regardless of whether the emergency insulin was dispensed by
the DOH or a pharmacist.� However, the bill authorizes the DOH to furnish additional
emergency supplies of insulin to a person based on demonstrated need.� The bill
specifies that additional emergency supplies dispensed by the DOH over an
emergency 30-day supply will not be subject to the insurance coverage
requirements of the bill.

���� The DOH and pharmacists will
be required to report each emergency 30-day supply of insulin dispensed under
the bill to the prescription monitoring database maintained pursuant to
P.L.2007, c.244 (C.45:1-44 et al.) and will be required, prior to dispensing an
emergency 30-day supply of insulin, to review the person�s prescription
monitoring information to determine whether the person was dispensed an
emergency 30-day supply of insulin by the DOH or by a pharmacy in the preceding
12 months.

���� The bill requires health
insurers, Medicaid, the State Health Benefits Program, and the School
Employees� Health Benefits Program to provide coverage for emergency 30-day
supplies of insulin dispensed under the bill at least once every 12 months.�
The coverage requirement includes the
health benefits plan of a hospital, medical or health service
corporation, individual, small employer, large group commercial insurer, and
health maintenance organization.