ASSEMBLY HEALTH AND SENIOR SERVICES COMMITTEE

STATEMENT TO

ASSEMBLY, No. 4271

with committee amendments

STATE OF NEW JERSEY

DATED:  JUNE 1, 2015

      The Assembly Health and Senior Services Committee reports favorably and with committee amendments Assembly Bill No. 4271.

      As amended, this bill requires health insurers to provide health benefits coverage for prescribed abuse-deterrent opioid analgesic drugs.  Opioid analgesic drugs are drugs prescribed to treat moderate to severe pain or other conditions.  Abuse-deterrent opioid analgesic drugs are drugs approved by the U.S. Food and Drug Administration with abuse-deterrence labeling claims that indicate the drug is expected to result in a meaningful reduction in abuse.

      As amended, the bill requires that, if the health insurer provides prescription drug benefits through use of a formulary, all abuse-deterrent opioid analgesic drugs would be included on the most preferred tier of the formulary.  Cost-sharing for abuse-deterrent opioid analgesic drugs would not exceed the lowest cost-sharing level applied to other prescription drugs, and any prior authorization requirements or other utilization review measures for opioid analgesic drugs would not require first use of non-abuse-deterrent opioid analgesic drugs in order to access opioid analgesic drugs with abuse-deterrent properties.

      The bill applies to health, hospital and medical service corporations; commercial individual and group health insurers; health maintenance organizations; health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs; the State Health Benefits Program; and the School Employees’ Health Benefits Program.

COMMITTEE AMENDMENTS:

      The committee amendments clarify that, if a health insurer provides prescription drug benefits through the use of a formulary, all abuse-deterrent opioid analgesic drugs are required to be on the most preferred tier of the formulary; as introduced, the pertinent sections did not include the word “all.”

      The committee amendments make a technical revision to the synopsis.