26:2S-38 Prescription drug benefit carrier contracts, opioid antidote coverage.
200 words·~1 min read·
/nj/title-26/chapter-2s/26-2s-38A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
1. a. A carrier shall ensure that every contract to provide prescription drug benefits, or to authorize the purchase of a contract to provide prescription drug benefits, shall provide coverage for an opioid antidote to covered persons without the imposition of any prior authorization or other utilization management requirements, provided that the drug is:
(1)prescribed or administered to the covered person by a licensed medical practitioner who is authorized to prescribe or administer that treatment pursuant to State and federal law; or
(2)dispensed to the covered person by a licensed pharmacist under a standing order to dispense an opioid antidote pursuant to section 1 of P.L.2017, c.88 (C.45:14-67.2).
b. The provisions of this section shall not be construed to limit the coverage of an opioid antidote only when administered by a medical practitioner.
c. As used in this section:
"Carrier" means 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.
"Opioid antidote" means naloxone hydrochloride, or any other similarly acting drug approved by the United States Food and Drug Administration for self-administration for the treatment of an opioid overdose.
L.2021, c.157, s.1.