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A4550
ASSEMBLY, No. 4550
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED MARCH 10, 2026
Sponsored by:
Assemblywoman� CAROL A. MURPHY
District 7 (Burlington)
SYNOPSIS
���� Requires health benefits coverage for buprenorphine
and buprenorphine/naloxone for pain treatment without step therapy or
fail-first protocols.
CURRENT VERSION OF TEXT
���� As introduced.
��
An Act
concerning health benefits coverage for
buprenorphine and buprenorphine/naloxone for pain treatment and supplementing
various parts of the statutory law.
����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:
���� 1.��� a. Notwithstanding any
other provision of law to the contrary, a hospital service corporation contract
that provides hospital or medical expense benefits and is delivered, issued,
executed or renewed in this State, 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 coverage for any expenses incurred by a covered
person for the prescription and purchase of
buprenorphine
or buprenorphine/naloxone for the treatment of pain
.� Coverage provided
pursuant to this section shall not be subject to step therapy or fail-first
protocols.
���� b.��� The provisions of this
section shall apply to all hospital service corporation contracts in which the
hospital service corporation has reserved the right to change the premium.
���� 2.��� a. Notwithstanding any
other provision of law to the contrary, a medical service corporation contract
that provides hospital or medical expense benefits and is delivered, issued,
executed or renewed in this State, 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 coverage for any expenses incurred by a covered
person for the prescription and purchase of
buprenorphine
or buprenorphine/naloxone for the treatment of pain
.� Coverage provided
pursuant to this section shall not be subject to step therapy or fail-first
protocols.
���� b.��� The provisions of this
section shall apply to all medical service corporation contracts in which the
medical service corporation has reserved the right to change the premium.
���� 3.��� a. Notwithstanding any
other provision of law to the contrary, a health service corporation contract
that provides hospital or medical expense benefits and is delivered, issued,
executed or renewed in this State, 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 coverage for any expenses incurred by a covered
person for the prescription and purchase of
buprenorphine
or buprenorphine/naloxone for the treatment of pain
.� Coverage provided
pursuant to this section shall not be subject to step therapy or fail-first
protocols.
���� b.��� The provisions of this
section shall apply to all health service corporation contracts in which the
health service corporation has reserved the right to change the premium.
���� 4.��� a. Notwithstanding any
other provision of law to the contrary, an individual health insurance policy
that provides hospital or medical expense benefits and is delivered, issued,
executed or renewed in this State, 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 coverage for any expenses incurred by a covered
person for the prescription and purchase of
buprenorphine
or buprenorphine/naloxone for the treatment of pain
.� Coverage provided
pursuant to this section shall not be subject to step therapy or fail-first
protocols.
���� b.��� The provisions of this
section shall apply to those policies in which the insurer has reserved the
right to change the premium.
���� 5.��� a. Notwithstanding any
other provision of law to the contrary, a group health insurance policy that
provides hospital or medical expense benefits and is delivered, issued,
executed or renewed in this State, 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 coverage for any expenses incurred by a covered
person for the prescription and purchase of
buprenorphine
or buprenorphine/naloxone for the treatment of pain
.� Coverage provided
pursuant to this section shall not be subject to step therapy or fail-first
protocols.
���� b.��� The provisions of this
section shall apply to those policies in which the insurer has reserved the
right to change the premium.
���� 6.��� a. Notwithstanding any
other provision of law to the contrary, an individual health benefits plan that
provides hospital or medical expense benefits and is delivered, issued,
executed or renewed in this State, 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 coverage for any expenses incurred by a covered person
for the prescription and purchase of
buprenorphine
or buprenorphine/naloxone for the treatment of pain
.� Coverage provided
pursuant to this section shall not be subject to step therapy or fail-first
protocols.
���� b.��� The provisions of this
section shall apply to all individual health benefits plans in which the
carrier has reserved the right to change the premium.
���� 7.��� a. Notwithstanding any
other provision of law to the contrary, a small employer health benefits plan
that provides hospital or medical expense benefits and is delivered, issued,
executed or renewed in this State, 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 coverage for any expenses incurred by a covered
person for the prescription and purchase of
buprenorphine
or buprenorphine/naloxone for the treatment of pain
.� Coverage provided
pursuant to this section shall not be subject to step therapy or fail-first
protocols.
���� b.��� The provisions of this
section shall apply to all small employer health benefits plans in which the
carrier has reserved the right to change the premium.
���� 8.��� a. Notwithstanding any
other provision of law to the contrary, a health maintenance organization
contract that provides hospital or medical expense benefits and is delivered,
issued, executed or renewed in this State, 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 coverage for any expenses incurred by
a covered person for the prescription and purchase of
buprenorphine or buprenorphine/naloxone for the
treatment of pain
.� Coverage provided pursuant to this section shall not
be subject to step therapy or fail-first protocols.
���� b.��� The provisions of this
section shall apply to those contracts for health care services by health
maintenance organizations under which the health maintenance organization has
reserved the right to change the schedule of charges.
���� 9.��� 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 or
medical expense benefits shall provide coverage for any expenses incurred by a
covered person for the prescription and purchase of buprenorphine or
buprenorphine/naloxone for the treatment of pain.� Coverage provided pursuant
to this section shall not be subject to step therapy or fail-first protocols.
���� 10.� 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 or
medical expense benefits shall provide coverage for any expenses incurred by a
covered person for the prescription and purchase of buprenorphine or
buprenorphine/naloxone for the treatment of pain.� Coverage provided pursuant
to this section shall not be subject to�� step therapy or fail-first protocols.
���� 11.� This act shall take
effect on the 90th day next following the date of enactment.
STATEMENT
���� This bill requires health
insurers (health, hospital and medical service corporations, commercial
individual and group health �insurers; health maintenance organizations, health
benefits plans issued pursuant to the New Jersey Individual Health Coverage and
Small Employer Health Benefits Programs, the State Health �Benefits Program,
and the School Employees� Health Benefits �Program) to provide health benefits
coverage for any expenses �incurred by a covered person for the prescription
and purchase of �buprenorphine or buprenorphine/naloxone for the treatment of �pain.
The bill provides that coverage is not subject to step therapy or fail-first
protocols.
���� Buprenorphine and
buprenorphine/naloxone, are medications that are used to treat chronic pain.
This bill seeks to make these medications more readily available for people
with chronic pain by prohibiting health insurers from applying step therapy or
fail-first protocols as a condition for coverage.� These protocols are a type
of prior authorization which currently may be used by health insurers to
require patients to use riskier, more addictive drugs for the treatment of
pain, before using buprenorphine and buprenorphine/naloxone, which are less
addictive and less likely to be abused by patients.