S845 1R

An Act concerning contraceptives, supplementing P.L.2003, c.280 (C.45:14-40 et seq.), and amending P.L.2005, c.251.

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

1. (New section) a. Notwithstanding any other law to the contrary, a pharmacist ¹[may] shall be authorized to¹ furnish self-administered hormonal contraceptives to a patient, in accordance with standardized procedures and protocols to be jointly developed and approved by the Board of Pharmacy and the State Board of Medical Examiners, in consultation with the American Congress of Obstetricians and Gynecologists, the New Jersey Pharmacists Association, and other appropriate entities, and in accordance with the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.) and the provisions of this subsection.

b. At a minimum, the standardized procedures and protocols adopted under this subsection shall:

(1) ¹require a pharmacist, as a condition of furnishing self-administered hormonal contraceptives to patients pursuant to this section, to complete a training program jointly approved by the Board of Pharmacy and the State Board of Medical Examiners;

(2)¹ provide for the issuance of a standing order authorizing pharmacists in this State to furnish self-administered hormonal contraceptives to patients without an individual prescription;

¹[(2)] (3)¹ identify the self-administered hormonal contraceptives that a pharmacist will be authorized to furnish to patients pursuant to the standing order;

¹[(3)] (4)¹ require a pharmacist to make clinical decisions that are free from any financial influence imposed by insurance providers, contraceptive product manufacturers, and other parties having a financial interest in the disbursement or non-disbursement of self-administered hormonal contraceptives;

¹[(4)] (5)¹ require a patient, prior to obtaining a self-administered hormonal contraceptive pursuant to this section, to use a self-screening tool that will identify patient risk factors for the use of self-administered hormonal contraceptives, based on the current United States Medical Eligibility Criteria for Contraceptive Use (US MEC) developed by the federal Centers for Disease Control and Prevention;

¹[(5)] (6)¹ require a pharmacist to offer to provide counseling to a patient about other forms of contraception that have been approved by the federal Food and Drug Administration, and, if the patient accepts the offer for counseling, require the pharmacist to provide the patient with specific and appropriate information about such other forms of contraception, based on the results of the self-screening tool administered pursuant to paragraph ¹[(4)] (5)¹ of this subsection; and

¹[(6)] (7)¹ require a pharmacist, upon furnishing a self-administered hormonal contraceptive to a patient, or upon determining that a self-administered hormonal contraceptive is not recommended, to refer the patient to the patient’s primary care provider, or, if the patient does not have a primary care provider, to an appropriate and nearby medical clinic.

c. The Board of Pharmacy and the Board of Medical Examiners are both authorized to ensure compliance with the provisions of this section, and each board is specifically charged with the enforcement of this section as applied to its respective licensees.

d. As used in this section, “self-administered hormonal contraceptive” means any oral, transdermal, or vaginal contraceptive product, including, but not limited to, birth control pills, vaginal rings, and diaphragms.

e. Nothing in this section shall be deemed to expand the authority of a pharmacist to prescribe any prescription medication.

¹2. (New section) The Commissioner of Health shall establish a public awareness campaign to inform the general public concerning the ability to obtain self-administered hormonal contraceptives from a pharmacy without an individual prescription pursuant to the provisions of section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill). There shall be appropriated to the Department of Health such funding as shall be necessary to implement the provisions of this section.¹

¹[2.] 3.¹ Section 1 of P.L.2005, c.251 (C.17:48-6ee) is amended to read as follows:

1. a. A hospital service corporation that provides hospital or medical expense benefits for expenses incurred in the purchase of outpatient prescription drugs under a contract shall provide coverage under every such contract 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] P.L.2005, c.251 (C.17:48-6ee et al.), for expenses incurred in the purchase of prescription female contraceptives.

b. For the purposes of this section, "prescription female [contraceptives] contraceptive" means any drug or device that is used for contraception by a female, [which] is approved by the federal Food and Drug Administration for that purpose, [that] and can only be purchased in this State [with] pursuant to a prescription written by a health care professional who is licensed or authorized to write prescriptions, [and] or pursuant to a standing order issued in accordance with procedures and protocols adopted by the Board of Pharmacy and the State Board of Medical Examiners pursuant to section 1 of P.L. , c. (C. ) (pending before the Legislature as this bill). “Prescription female contraceptive” includes, but is not limited to, birth control pills, vaginal rings, and diaphragms.

c. A religious employer may request, and a hospital service corporation shall grant, exclusion under the contract for the coverage required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective subscribers and subscribers. The provisions of this section shall not be construed as authorizing a hospital service corporation to exclude coverage for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of a subscriber. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3).

d. The benefits under this section shall be provided to the same extent as for any other outpatient prescription drug under the contract.

e. This section shall apply to those contracts in which the hospital service corporation has reserved the right to change the premium.

(cf: P.L.2005, c.251, s.1)

¹[3.] 4.¹ Section 2 of P.L.2005, c.251 (C.17:48A-7bb) is amended to read as follows:

2. a. A medical service corporation that provides hospital or medical expense benefits for expenses incurred in the purchase of outpatient prescription drugs under a contract shall provide coverage under every such contract 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] P.L.2005, c.251 (C.17:48-6ee et al.), for expenses incurred in the purchase of prescription female contraceptives.

c. A religious employer may request, and a medical service corporation shall grant, an exclusion under the contract for the coverage required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective subscribers and subscribers. The provisions of this section shall not be construed as authorizing a medical service corporation to exclude coverage for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of a subscriber. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3).

d. The benefits under this section shall be provided to the same extent as for any other outpatient prescription drug under the contract.

e. This section shall apply to those contracts in which the medical service corporation has reserved the right to change the premium.

(cf: P.L.2005, c.251, s.2)

¹[4.] 5.¹ Section 3 of P.L.2005, c.251 (C.17:48E-35.29) is amended to read as follows:

3. a. A health service corporation that provides hospital or medical expense benefits for expenses incurred in the purchase of outpatient prescription drugs under a contract shall provide coverage under every such contract 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] P.L.2005, c.251 (C.17:48-6ee et al.), for expenses incurred in the purchase of prescription female contraceptives.

c. A religious employer may request, and a health service corporation shall grant, an exclusion under the contract for the coverage required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective subscribers and subscribers. The provisions of this section shall not be construed as authorizing a health service corporation to exclude coverage for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of a subscriber. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3).

d. The benefits under this section shall be provided to the same extent as for any other outpatient prescription drug under the contract.

e. This section shall apply to those contracts in which the health service corporation has reserved the right to change the premium.

(cf: P.L.2005, c.251, s.3)

¹[5.] 6.¹ Section 4 of P.L.2005, c.251 (C.17B:27-46.1ee) is amended to read as follows:

4. a. A group health insurer that provides hospital or medical expense benefits for expenses incurred in the purchase of outpatient prescription drugs under a policy shall provide coverage under every such policy 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] P.L.2005, c.251 (C.17:48-6ee et al.), for expenses incurred in the purchase of prescription female contraceptives.

c. A religious employer may request, and an insurer shall grant, an exclusion under the policy for the coverage required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective insureds and insureds. The provisions of this section shall not be construed as authorizing an insurer to exclude coverage for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of an insured. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3).

d. The benefits under this section shall be provided to the same extent as for any other outpatient prescription drug under the policy.

e. This section shall apply to those policies in which the insurer has reserved the right to change the premium.

(cf: P.L.2005, c.251, s.4)

¹[6.] 7.¹ Section 5 of P.L.2005, c.251 (C.17B:26-2.1y) is amended to read as follows:

5. a. An individual health insurer that provides hospital or medical expense benefits for expenses incurred in the purchase of outpatient prescription drugs under a policy shall provide coverage under every such policy 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] P.L.2005, c.251 (C.17:48-6ee et al.), for expenses incurred in the purchase of prescription female contraceptives.

d. The benefits under this section shall be provided to the same extent as for any other outpatient prescription drug under the policy.

e. This section shall apply to those policies in which the insurer has reserved the right to change the premium.

(cf: P.L.2005, c.251, s.5)

¹[7.] 8.¹ Section 6 of P.L.2005, c.251 (C.26:2J-4.30) is amended to read as follows:

6. a. A certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued on or after the effective date of [this act] P.L.2005, c.251 (C.17:48-6ee et al.), for a health maintenance organization that provides health care services for outpatient prescription drugs under a contract, unless the health maintenance organization also provides health care services for prescription female contraceptives.

c. A religious employer may request, and a health maintenance organization shall grant, an exclusion under the contract for the health care services required by this section if the required health care services conflict with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective enrollees and enrollees. The provisions of this section shall not be construed as authorizing a health maintenance organization to exclude health care services for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of an enrollee. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3).

d. The health care services under this section shall be provided to the same extent as for any other outpatient prescription drug under the contract.

e. The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the right to change the schedule of charges for enrollee coverage is reserved.

(cf: P.L.2005, c.251, s.6)

¹[8.] 9.¹ Section 7 of P.L.2005, c.251 (C.17B:27A-7.12) is amended to read as follows:

7. a. An individual health benefits plan required pursuant to section 3 of P.L.1992, c.161 (C.17B:27A-4) that provides benefits for expenses incurred in the purchase of outpatient prescription drugs shall provide coverage for expenses incurred in the purchase of prescription female contraceptives.

c. A religious employer may request, and a carrier shall grant, an exclusion under the health benefits plan for the coverage required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective covered persons and covered persons. The provisions of this section shall not be construed as authorizing a carrier to exclude coverage for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of a covered person. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3).

d. The benefits under this section shall be provided to the same extent as for any other outpatient prescription drug under the health benefits plan.

e. This section shall apply to all individual health benefits plans in which the carrier has reserved the right to change the premium.

(cf: P.L.2005, c.251, s.7)

¹[9.] 10.¹ Section 8 of P.L.2005, c.251 (C.17B:27A-19.15) is amended to read as follows:

8. a. A small employer health benefits plan required pursuant to section 3 of P.L.1992, c.162 (C.17B:27A-19) that provides benefits for expenses incurred in the purchase of outpatient prescription drugs shall provide coverage for expenses incurred in the purchase of prescription female contraceptives.

d. The benefits under this section shall be provided to the same extent as for any other outpatient prescription drug under the health benefits plan.

e. This section shall apply to all small employer health benefits plans in which the carrier has reserved the right to change the premium.

(cf: P.L.2005, c.251, s.8)

¹[10.] 11.¹ Section 9 of P.L.2005, c.251 (C.17:48F-13.2) is amended to read as follows:

9. a. A prepaid prescription service organization that provides benefits for expenses incurred in the purchase of outpatient prescription drugs under a contract shall provide coverage under every such contract 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] P.L.2005, c.251 (C.17:48-6ee et al.), for expenses incurred in the purchase of prescription female contraceptives.

c. A religious employer may request, and a prepaid prescription service organization shall grant, an exclusion under the contract for the coverage required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains such an exclusion shall provide written notice thereof to prospective enrollees and enrollees. The provisions of this section shall not be construed as authorizing a prepaid prescription service organization to exclude coverage for prescription drugs that are prescribed for reasons other than contraceptive purposes or for prescription female contraceptives that are necessary to preserve the life or health of an enrollee. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 U.S.C. s.3121(w)(3)(A), and that qualifies as a tax-exempt organization under 26 U.S.C. s.501(c)(3).

d. The benefits under this section shall be provided to the same extent as for any other outpatient prescription drug under the contract.

e. This section shall apply to those prepaid prescription contracts in which the prepaid prescription service organization has reserved the right to change the premium.

(cf: P.L.2005, c.251, s.9)

¹[11.] 12.¹ Section 10 of P.L.2005, c.251 (C.52:14-17.29j) is amended to read as follows:

10. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of [this act] P.L.2005, c.251 (C.17:48-6ee et al.) that provides benefits for expenses incurred in the purchase of outpatient prescription drugs shall provide benefits for expenses incurred in the purchase of prescription female contraceptives.

(cf: P.L.2005, c.251, s.10)

¹[12.] 13.¹ This act shall take effect on the first day of the fourth month next following the date of enactment, except that the Board of Pharmacy and the State Board of Medical Examiners may take any administrative action in advance thereof as shall be necessary for the implementation of this act.