Prohibits health insurance carriers from denying coverage of nonopioid prescription drugs in favor of opioid prescription drugs.

S4283

SENATE, No. 4283

STATE OF NEW JERSEY

222nd LEGISLATURE

�

INTRODUCED MAY 14, 2026

Sponsored by:

Senator� JOSEPH F. VITALE

District 19 (Middlesex)

SYNOPSIS

���� Prohibits health insurance carriers from denying
coverage of nonopioid prescription drugs in favor of opioid prescription drugs.

CURRENT VERSION OF TEXT

���� As introduced.

��

An Act

concerning nonopioid medication 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
law, rule, or regulation to the contrary, when a licensed health care provider
prescribes a nonopioid medication to a covered person for the treatment of
acute pain, it shall be unlawful for a carrier to deny coverage of a nonopioid
prescription drug:

���� (1)�� in favor of an opioid
prescription drug; or

���� (2)�� to require a covered
person to try an opioid prescription drug prior to approving the use of a
nonopioid prescription drug.

���� b.��� If a carrier establishes
and maintains a drug formulary, the carrier shall ensure that a nonopioid drug
approved by the United States Food and Drug Administration for the treatment or
management of pain will not be disadvantaged or discouraged, with respect to
coverage or cost-sharing, relative to any opioid or narcotic drug for the
treatment or management of pain on the formulary of the carrier, where
impermissible disadvantaging or discouragement includes, without limitation:

���� (1)�� imposing more
restrictive coverage criteria on any nonopioid drug than the least restrictive
criteria imposed on an opioid or narcotic drug;

���� (2)�� establishing more
restrictive or more extensive utilization controls, including, but not limited
to, more restrictive or more extensive prior authorization or step therapy
requirements, for nonopioid drugs than the least restrictive or extensive
utilization controls applicable to an opioid or narcotic drug; or

���� (3)�� if the carrier maintains
a formulary grouped into tiers for the purposes of determining cost-sharing,
placing any nonopioid drug on a tier that requires a cost-sharing
responsibility that exceeds the lowest cost-sharing responsibility required for
an opioid or narcotic drug on the formulary.

���� c.���� Subsection b. of this
section shall not preclude:

���� (1)�� opioid drugs from being
preferred over other opioid drugs; or

���� (2)�� nonopioid drugs from
being preferred over other nonopioid drugs.

���� 2.��� a.� Notwithstanding any
law, rule, or regulation to the contrary, the State Health Benefits Commission
shall ensure that in every contract providing hospital or medical expense
benefits that is purchased by the commission on or after the effective date of
this act, a nonopioid medication prescribed to a covered person for the
treatment of acute pain shall not be denied coverage:

���� (1)�� in favor of an opioid
prescription drug; or

���� (2)�� so that a covered person
be required to try an opioid prescription drug prior to approving the use of a
nonopioid prescription drug.

���� b.��� For contracts that use
and maintain a drug formulary, it shall be required that a nonopioid drug
approved by the United States Food and Drug Administration for the treatment or
management of pain will not be disadvantaged or discouraged, with respect to coverage
or cost-sharing, relative to any opioid or narcotic drug for the treatment or
management of pain on the formulary.� Impermissible disadvantaging or
discouragement includes, without limitation:

���� (1)�� imposing more
restrictive coverage criteria on any nonopioid drug than the least restrictive
criteria imposed on an opioid or narcotic drug;

���� (2)�� establishing more
restrictive or more extensive utilization controls, including, but not limited
to, more restrictive or more extensive prior authorization or step therapy
requirements, for nonopioid drugs than the least restrictive or extensive
utilization controls applicable to an opioid or narcotic drug; or

���� (3)�� if the contract uses and
maintains a formulary grouped into tiers for the purposes of determining
cost-sharing, placing any nonopioid drug on a tier that requires a cost-sharing
responsibility that exceeds the lowest cost-sharing responsibility required for
an opioid or narcotic drug on the formulary.

���� c.���� Subsection b. of this
section shall not preclude:

���� (1)�� opioid drugs from being
preferred over other opioid drugs; or

���� (2)�� nonopioid drugs from
being preferred over other nonopioid drugs.

��

���� 3.��� a.� Notwithstanding any
law, rule, or regulation to the contrary, the School Employees� Health Benefits
Commission shall ensure that in every contract providing hospital or medical
expense benefits, which is purchased by the commission on or after the effective
date of this act, a nonopioid medication prescribed to a covered person for the
treatment of acute pain shall not be denied coverage:

���� (1)�� in favor of an opioid
prescription drug; or

���� (2)�� so that a covered person
be required to try an opioid prescription drug prior to approving the use of a
nonopioid prescription drug.

���� b.��� For contracts that use
and maintain a drug formulary, it shall be required that a nonopioid drug
approved by the United States Food and Drug Administration for the treatment or
management of pain will not be disadvantaged or discouraged, with respect to coverage
or cost-sharing, relative to any opioid or narcotic drug for the treatment or
management of pain on the formulary, where impermissible disadvantaging or
discouragement includes, without limitation:

���� (1)�� imposing more
restrictive coverage criteria on any nonopioid drug than the least restrictive
criteria imposed on an opioid or narcotic drug;

���� (2)�� establishing more
restrictive or more extensive utilization controls, including, but not limited
to, more restrictive or more extensive prior authorization or step therapy
requirements, for nonopioid drugs than the least restrictive or extensive
utilization controls applicable to an opioid or narcotic drug; or

���� (3)�� if the contract uses and
maintains a formulary grouped into tiers for the purposes of determining
cost-sharing, placing any nonopioid drug on a tier that requires a cost-sharing
responsibility that exceeds the lowest cost-sharing responsibility required for
an opioid or narcotic drug on the formulary.

���� c.���� Subsection b. of this
section shall not preclude:

���� (1)�� opioid drugs from being
preferred over other opioid drugs; or

���� (2)�� nonopioid drugs from
being preferred over other nonopioid drugs.

����

���� 4.��� a.� Notwithstanding any
State law, rule, or regulation to the contrary, whenever a licensed health care
provider prescribes a nonopioid medication for the treatment of acute pain to
persons served under the Medicaid program, established pursuant to P.L.1968,
c.413 (C.30:4D-1 et seq.), the Department of Human Services shall not deny
coverage of the nonopioid prescription drug:

���� (1)�� in favor of an opioid
prescription drug; or

���� (2)�� so that a covered person
be required to try an opioid prescription drug prior to approving use of a
nonopioid prescription drug.

���� b.��� In establishing and
maintaining a preferred drug list, the Department of Human Services shall
ensure that nonopioid drugs on the list, and approved by the United States Food
and Drug Administration, for the treatment or management of pain shall not be
disadvantaged or discouraged with respect to coverage relative to any opioid or
narcotic drug for the treatment or management of pain.

���� 5.��� This act shall take
effect on January 1, 2027 and shall apply to policies, plans, and contracts
that are delivered, issued, executed, or renewed on or after that date.

STATEMENT

���� This bill makes it unlawful
when a licensed health care provider prescribes a nonopioid medication to a
person covered by a health insurance carrier for the treatment of acute pain
and the carrier denies coverage of a nonopioid prescription drug:� (1) in favor
of an opioid prescription drug; or (2) to require a covered person to try an
opioid prescription drug prior to approving the use of a nonopioid prescription
drug.� �Carrier� is defined in the bill to mean an insurance company, health
service corporation, hospital service corporation, medical service corporation,
or health maintenance organization authorized to issue health benefits plans in
this State.�

���� Under the bill, a carrier that
establishes and maintains a drug formulary is to ensure that a nonopioid drug
approved by the United States Food and Drug Administration for the treatment or
management of pain will not be disadvantaged or discouraged, with respect to
coverage or cost-sharing, relative to any opioid or narcotic drug for the
treatment or management of pain on the formulary of the carrier under various
circumstances.� It is not prohibited in the bill for an opioid drug to be
preferred over another opioid drug or for a nonopioid drug to be preferred over
another nonopioid drug.

���� The provisions of the bill
prohibiting denial of a nonopioid prescription drug are also incorporated into
the laws governing the required coverage for contracts negotiated by the State
Health Benefits Commission and the School Employees� Health Benefits Commission,
and in the law overseeing Medicaid.