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S4201
SENATE, No. 4201
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED MAY 11, 2026
Sponsored by:
Senator� RAJ MUKHERJI
District 32 (Hudson)
SYNOPSIS
���� Authorizes coverage of prescriptive hormone
replacement therapy.
CURRENT VERSION OF TEXT
���� As introduced.
��
An Act
concerning prescriptive hormone replacement
therapy and supplementing P.L.1997, c.192 (C.26:2S-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.��� a.� A health benefits
plan of a carrier or a contract for hospital and medical expense benefits
purchased by the State Health Benefits Commission or the School Employees�
Health Benefits Commission shall provide benefits to a covered person for a
12-month refill of prescription hormone replacement therapy if the prescription
therapy does not require refrigeration.
���� b.��� If a prescription
hormone replacement therapy is a controlled dangerous substance, a health
benefits plan of a carrier or a contract for hospital and medical expense
benefits purchased by the State Health Benefits Commission or the School
Employees� Health Benefits Commission shall provide the maximum refill allowed
under State and federal law that may be obtained at one time by a covered
person.
���� c.���� Nothing in this section
prohibits a health benefits plan of a carrier or a contract for hospital and
medical expense benefits purchased by the State Health Benefits Commission or
the School Employees� Health Benefits Commission from limiting refills that may
be obtained in the last quarter of the plan year if a 12-month supply of the
prescription hormone replacement therapy has already been dispensed during the
plan year.
���� d.��� Nothing in this section
prohibits a prescribing provider from temporarily limiting refills that may be
obtained at one time to a 90-day supply if the prescription hormone replacement
therapy is experiencing an acute dispensing shortage during the plan year,
provided that limits shall be rescinded at first opportunity of a regularly
reinstated, sustainable supply.
���� e.���� To the extent not
otherwise prohibited under this section or State or federal law, a health
benefits plan of a carrier or a contract for hospital and medical expense
benefits purchased by the State Health Benefits Commission or the School
Employees� Health Benefits Commission may apply drug utilization management
strategies to prescription drugs covered under subsection a. of this section.
���� f.���� For purposes of this
section, �prescription hormone replacement therapy� means all drugs approved by
the United States Food and Drug Administration that are used to medically
suppress, increase, or replace hormones that the body is not producing at
intended levels.� �Prescription hormone replacement therapy� shall not include
glucagon-like peptide-1 and glucagon-like peptide-1 receptor agonists.
���� 2.��� a.� Notwithstanding any
State law or regulation to the contrary, the Department of Human Services shall
ensure that expenses incurred for a 12-month refill of prescription hormone
replacement therapy if the prescription therapy does not require refrigeration
shall be provided with no cost-sharing to persons served under the Medicaid
program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
���� b.��� If a prescription
hormone replacement therapy is a controlled dangerous substance, the maximum
refill allowed under State and federal law may be obtained at one time by
persons served under the Medicaid program.
���� c.���� Nothing in this section
shall prohibit a limitation on refills that may be obtained in the last quarter
of the plan year if a 12-month supply of the prescription hormone replacement
therapy has already been dispensed during the plan year.
���� d.��� Nothing in this section
prohibits a temporary limit on refills that may be obtained at one time to a
90-day supply if the prescription hormone replacement therapy is experiencing
an acute dispensing shortage during the plan year, provided that limits shall
be rescinded at first opportunity of a regularly reinstated, sustainable
supply.
���� e.���� For purposes of this
section, �prescription hormone replacement therapy� means all drugs approved by
the United States Food and Drug Administration that are used to medically
suppress, increase, or replace hormones that the body is not producing at
intended levels.� �Prescription hormone replacement therapy� shall not include
glucagon-like peptide-1 and glucagon-like peptide-1 receptor agonists.
���� 3.��� This act shall take
effect immediately and shall apply to health benefits plans and contracts
issued or renewed on or after the date of enactment.
STATEMENT
����
���� This bill requires a health
benefits plan of a carrier; a contract for hospital and medical expense
benefits purchased by the State Health Benefits Commission or the School
Employees� Health Benefits Commission; and Medicaid to provide benefits to a
covered person for a 12-month refill of prescription hormone replacement
therapy if the prescription therapy does not require refrigeration.� In the
bill, �prescription hormone replacement therapy� means all drugs approved by
the United States Food and Drug Administration that are used to medically
suppress, increase, or replace hormones that the body is not producing at
intended levels but excludes glucagon-like peptide-1 and glucagon-like
peptide-1 receptor agonists.
���� Under the bill, if a
prescription hormone replacement therapy is a controlled dangerous substance, a
health benefits plan of a carrier; a contract for hospital and medical expense
benefits purchased by the State Health Benefits Commission or the School Employees�
Health Benefits Commission; and Medicaid are to provide the maximum refill
allowed under State and federal law that may be obtained at one time by a
covered person.� A health benefits plan of a carrier; a contract for hospital
and medical expense benefits purchased by the State Health Benefits Commission
or the School Employees� Health Benefits Commission; and Medicaid are not
prohibited from limiting refills that may be obtained in the last quarter of
the plan year if a 12-month supply of the prescription hormone replacement
therapy has already been dispensed during the plan year.
���� Nothing in the bill is to
prohibit a prescribing provider from temporarily limiting refills that may be
obtained to a 90-day supply at one time if the prescription hormone replacement
therapy is experiencing an acute dispensing shortage during the plan year,
provided the limits are to be rescinded at first opportunity of a regularly
reinstated, sustainable supply.� To the extent not otherwise prohibited under
the bill or State or federal law, a health benefits plan of a carrier or a
contract for hospital and medical expense benefits purchased by the State
Health Benefits Commission or the School Employees� Health Benefits Commission
may apply drug utilization management strategies to prescription drugs.