Requires coverage of clinician-administered drugs without additional financial penalties or certain limitations on location of administration of drugs.

A5270

ASSEMBLY, No. 5270

STATE OF NEW JERSEY

222nd LEGISLATURE

�

INTRODUCED JUNE 15, 2026

Sponsored by:

Assemblywoman� CAROL A. MURPHY

District 7 (Burlington)

Assemblyman� ANTHONY ANGELOZZI

District 8 (Atlantic and Burlington)

SYNOPSIS

���� Requires coverage of clinician-administered drugs
without additional financial penalties or certain limitations on location of
administration of drugs.

CURRENT VERSION OF TEXT

���� As introduced.

��

An Act

concerning patient choice in dispensing of
certain prescription drugs and biologics and supplementing P.L.1997, c.192
(C.26:2S-1 et seq.).

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

���� 1.��� As used in this act:

���� �Clinician-administered drug�
means a prescription drug or biologic other than a vaccine that:

���� (1) cannot reasonably be
self-administered by the patient to whom the drug is prescribed or by an
individual assisting the patient with the self-administration; and

���� (2) is typically administered:

���� (a) by a health care provider
authorized under the laws of this State to administer the drug, including when
acting under the delegation and supervision of a physician;

���� (b) in a physician �s office,
hospital outpatient infusion center, or other clinical setting; and

���� (c) only after a comprehensive
pharmacist review in accordance with a patient care treatment plan.

�

���� 2.��� A carrier or pharmacy
benefits manager shall not:

���� a.���� refuse to authorize,
approve, or pay a participating health care provider for issuing covered clinician-administered
drugs and related services to covered persons;

���� b.��� impose coverage or
benefits limitations, or require a covered person to pay an additional fee,
higher copay, higher coinsurance, second copay, second coinsurance, or other
penalty when obtaining clinician-administered drugs from a health care provider
authorized under the laws of this State to administer clinician-administered
drugs, or a pharmacy;

���� c.���� interfere with the covered
person�s right to choose to obtain a clinician-administered drug from the
health care provider or pharmacy of choice, including inducement, steering, or
offering financial or other incentives;

���� d.��� require
clinician-administered drugs to be dispensed by a pharmacy selected by the carrier
or pharmacy benefits manager;

���� e.���� limit or exclude
coverage for a clinician-administered drug when not dispensed by a pharmacy
selected by the carrier or pharmacy benefits manager if the drug would
otherwise be covered;

���� f.���� reimburse at a lesser
amount clinician-administered drugs dispensed by a pharmacy not selected by the
carrier or pharmacy benefits manager; or

���� g.��� require a pharmacy to
dispense a clinician-administered medication directly to a covered person with
the intention that the covered person will transport the medication to a
healthcare provider for administration.�

���� For purposes of this section,
the location of administering the clinician-administered drug shall not be
included as part of the criteria reviewed to determine medical necessity.

���� 3.��� A carrier or pharmacy
benefits manager may offer, but shall not require, the use of:

���� a.���� a home infusion
pharmacy to dispense clinician-administered drugs to covered persons in their
homes; or

���� b.��� an infusion site
external to the office or clinic of the covered person�s health care provider.

���� 4.��� The Commissioner of
Banking and Insurance may, pursuant to the �Administrative Procedure Act,�
P.L.1968, c.410 (C.52:14B-1 et seq.), promulgate rules and regulations to
effectuate the provisions of this act.

���� 5.��� This act shall take
effect on the first day of the seventh month next and shall apply to contracts
or policies issued or renewed on or after the date of enactment.

STATEMENT

���� This bill establishes certain
prohibitions for a carrier and pharmacy benefits manager in providing coverage
for clinician-administered drugs and related services to persons covered under
the plan or by the pharmacy benefits manager.� Specifically, a carrier and a
pharmacy benefits manager may not, among other items: (1) refuse to authorize,
approve, or pay a participating health care provider for issuing covered clinician-administered
drugs and related services to covered persons; (2) interfere with a covered
person�s right to choose to obtain a clinician-administered drug from the
health care provider or pharmacy of choice; and (3) limit or exclude coverage
for a clinician-administered drug when not dispensed by a pharmacy selected by
the carrier or pharmacy benefits manager if the drug would otherwise be covered.

���� Under the bill, a carrier or
pharmacy benefits manager may offer, but is not to require, the use of: (1) a
home infusion pharmacy to dispense clinician-administered drugs to covered
persons in their homes; or (2) an infusion site external to the office or
clinic of the covered person�s health care provider.