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.

S3712

SENATE, No. 3712

STATE OF NEW JERSEY

222nd LEGISLATURE

�

INTRODUCED MARCH 2, 2026

Sponsored by:

Senator� RAJ MUKHERJI

District 32 (Hudson)

Senator� VIN GOPAL

District 11 (Monmouth)

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 introduced.

��

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.

STATEMENT

���� This bill would prohibit contracts
which are issued or purchased pursuant to the State Health Benefits Program,
School Employees� Health Benefits Program, and Medicaid Program from denying
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 health benefits plan or the pharmacy benefits manager for that plan.

���� The prohibition applies only
if the covered person was taking the medication prior to the date of the change
in the covered person's health benefits plan or the pharmacy benefits manager
for that plan, and if the covered person's new health benefits plan, or health
benefits plan under the new pharmacy benefits manager, as applicable, provides
coverage for that class of drugs.