Sponsored by:
Assemblywoman CAROL A. MURPHY
District 7 (Burlington)
Assemblyman JOHN F. MCKEON
District 27 (Essex and Morris)
Assemblywoman SHANIQUE SPEIGHT
District 29 (Essex)
Co-Sponsored by:
Assemblymen Wimberly and Catalano
SYNOPSIS
Requires health insurance coverage of prescribed anti-obesity medication.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health insurance coverage for certain anti-obesity 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. A hospital service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), 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, shall provide benefits to any named subscriber or other person covered thereunder for expenses incurred in obtaining prescribed anti-obesity medication.
b. The benefits shall be provided to the same extent as for any other medical condition under the contract.
c. The provisions of this section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
d. For the purpose of this section, “anti-obesity medication” means any medication approved by the United States Food and Drug Administration that provides for chronic weight management in patients with obesity.
2. a. Every medical service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), 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, shall provide benefits to any named subscriber or other person covered thereunder for expenses incurred in obtaining prescribed anti-obesity medication.
b. The benefits shall be provided to the same extent as for any other medical condition under the contract.
c. The provisions of this section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
d. For the purpose of this section, “anti-obesity medication” means any medication approved by the United States Food and Drug Administration that provides for chronic weight management in patients with obesity.
3. a. Every health service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.), 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, shall provide benefits to any named subscriber or other person covered thereunder for expenses incurred in obtaining prescribed anti-obesity medication.
b. The benefits shall be provided to the same extent as for any other medical condition under the contract.
c. The provisions of this section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.
d. For the purpose of this section, “anti-obesity medication” means any medication approved by the United States Food and Drug Administration that provides for chronic weight management in patients with obesity.
4. a. Every individual policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S. 17B:26-1 et seq., 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, shall provide benefits to any named insured or other person covered thereunder for expenses incurred obtaining prescribed anti-obesity medication.
b. The benefits shall be provided to the same extent as for any other medical condition under the policy.
c. The provisions of this section shall apply to all health insurance policies in which the insurer has reserved the right to change the premium.
d. For the purpose of this section, “anti-obesity medication” means any medication approved by the United States Food and Drug Administration that provides for chronic weight management in patients with obesity.
5. a. Every group policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:27-26 et seq., 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, shall provide benefits to any named insured or other person covered thereunder for expenses incurred in obtaining prescribed anti-obesity medication.
b. The benefits shall be provided to the same extent as for any other medical condition under the policy.
c. The provisions of this section shall apply to all health insurance policies in which the insurer has reserved the right to change the premium.
d. For the purpose of this section, “anti-obesity medication” means any medication approved by the United States Food and Drug Administration that provides for chronic weight management in patients with obesity.
6. a. Every enrollee agreement that provides hospital or medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), 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, shall provide health care services to any enrollee or other person covered thereunder for expenses incurred in obtaining prescribed anti-obesity medication.
b. The health care services shall be provided to the same extent as for any other medical condition under the enrollee agreement.
c. The provisions of this section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges.
d. For the purpose of this section, “anti-obesity medication” means any medication approved by the United States Food and Drug Administration that provides for chronic weight management in patients with obesity.
7. a. Every individual health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), or approved for issuance or renewal in this State on or after the effective date of this act, shall provide benefits to any person covered thereunder for expenses incurred in obtaining prescribed anti-obesity medication.
b. The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
c. The provisions of this section shall apply to all individual health benefits plans in which the carrier has reserved the right to change the premium.
d. For the purpose of this section, “anti-obesity medication” means any medication approved by the United States Food and Drug Administration that provides for chronic weight management in patients with obesity.
8. a. Every small employer health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), or approved for issuance or renewal in this State on or after the effective date of this act, shall provide benefits to any person covered thereunder for expenses incurred obtaining prescribed anti-obesity medication.
b. The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
c. The provisions of this section shall apply to all small business health benefits plans in which the carrier has reserved the right to change the premium.
d. For the purpose of this section, “anti-obesity medication” means any medication approved by the United States Food and Drug Administration that provides for chronic weight management in patients with obesity.
9. a. 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 or medical expense benefits shall provide benefits to any person covered thereunder for expenses incurred in obtaining prescribed anti-obesity medication.
b. The benefits shall be provided to the same extent as for any other medical condition under the contract.
c. For the purpose of this section, “anti-obesity medication” means any medication approved by the United States Food and Drug Administration that provides for chronic weight management in patients with obesity.
10. a. 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 or medical expense benefits shall provide benefits to any person covered thereunder for expenses incurred in obtaining prescribed anti-obesity medication.
b. The benefits shall be provided to the same extent as for any other medical condition under the contract.
c. For the purpose of this section, “anti-obesity medication” means any medication approved by the United States Food and Drug Administration that provides for chronic weight management in patients with obesity.
11. This act shall take effect on the 90th day next following enactment and shall apply to policies and contracts that are delivered, issued, executed, or renewed on or after that date.
STATEMENT
This bill requires health insurance coverage of prescribed anti-obesity medication.
Specifically, under the bill, health insurance carriers (including insurance companies, hospital service corporations, medical service corporations, health service corporations, health maintenance organizations authorized to issue health benefits plans in New Jersey, and any entities contracted to administer health benefits in connection with the State Health Benefits Program and School Employees’ Health Benefits Program) will be required to cover prescribed anti-obesity medication that is approved by the U.S. Food and Drug Administration.
It is the intent of the sponsor of this bill that access to obesity medication be expanded and that greater attention be placed on obesity as a disease. Since 2013, the American Medical Association has recognized obesity as a disease requiring treatment and prevention efforts. According to the World Health Organization, obesity leads to a range of non-communicable diseases such as type 2 diabetes, cardiovascular disease, hypertension, stroke, various forms of cancer, and various mental health issues. It is estimated that almost one-third of American adults and 17% of American children ages two to 19 are obese. Globally, more than one billion people are considered to be obese, with an additional 167 million people expected to become obese by 2025. By expanding access to FDA-approved anti-obesity medication such as “Wegovy,” more individuals will be able to affordably access this effective treatment.