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A434 TR
ASSEMBLY, No. 434
STATE OF NEW JERSEY
222nd LEGISLATURE
�
PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION
Sponsored by:
Assemblyman MICHAEL VENEZIA
District 34 (Essex)
Assemblywoman VERLINA REYNOLDS-JACKSON
District 15 (Hunterdon and Mercer)
Assemblywoman� HEATHER SIMMONS
District 3 (Cumberland, Gloucester and Salem)
Co-Sponsored by:
Assemblyman Kearney
SYNOPSIS
���� Prohibits SHBP, SEHBP, and Medicaid from denying
coverage for maintenance medications for chronic conditions for covered persons
solely because of change in health benefits plan or pharmacy benefits manager.
CURRENT VERSION OF TEXT
���� As reported by the Assembly Financial Institutions
and Insurance Committee with technical review.
��
An Act
concerning health care coverage for certain
medications and supplementing P.L.1961, c.49 (C.52:14-17.25 et seq.), P.L.2007,
c.103 (C.52:14-17.46.1 et seq.), and P.L.1968, c.413 (C.30:4D-1 et seq.).
����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:
���� 1.��� Notwithstanding any
other law or regulation to the contrary, the State Health Benefits Commission
shall ensure that every contract purchased by the commission on or after the
effective date of this act that provides hospital and medical expense benefits shall
not deny coverage for a maintenance medication prescribed by a covered person�s
physician for the covered person�s chronic condition because of a change in the
covered person�s pharmaceutical benefits that results solely from a change in
the contract or the pharmacy benefits manager for that contract if:
���� a.��� the covered person was
taking the medication prior to the date of the change in the contract or the
pharmacy benefits manager for that contract; and
���� b.��� the new contract, or the
contract under the new pharmacy benefits manager, as applicable, provides
coverage for that class of drugs.
���� 2.��� Notwithstanding any
other law or regulation to the contrary, the School Employees� Health Benefits
Commission shall ensure that every contract purchased by the commission on or
after the effective date of this act that provides hospital and medical expense
benefits shall not deny coverage for a maintenance medication prescribed by a
covered person�s physician for the covered person�s chronic condition because
of a change in the covered person�s pharmaceutical benefits that results solely
from a change in the contract or the pharmacy benefits manager for that
contract if:
���� a.��� the covered person was
taking the medication prior to the date of the change in the contract or the
pharmacy benefits manager for that contract; and
���� b.��� the new contract, or the
contract under the new pharmacy benefits manager, as applicable, provides
coverage for that class of drugs.
���� 3.��� Notwithstanding the
provisions of any other law or regulation to the contrary, any contract between
a carrier and the Division of Medical Assistance and Health Services in the
Department of Human Services that provides benefits to persons who are eligible
for Medicaid under
P.L.1968, c.413 (C.30:4D-1 et seq.) shall not deny
coverage for a maintenance medication prescribed by a covered person�s
physician for the covered person�s chronic condition because of a change in the
covered person�s pharmaceutical benefits that results solely from a change in
the contract or the pharmacy benefits manager for that contract if:
���� a.��� the covered person was
taking the medication prior to the date of the change in the contract or the
pharmacy benefits manager for that contract; and
���� b.��� the new contract, or the
contract under the new pharmacy benefits manager, as applicable, provides
coverage for that class of drugs.
���� 4.��� This act shall take
effect on the first day of the seventh month next following the date of
enactment and shall apply to contracts issued or renewed on or after the
effective date.