30:4D-6q Medicaid, NJ FamilyCare, opioid antidote coverage.
265 words·~1 min read·
/nj/title-30/chapter-4d/30-4d-6qA research copy — for the controlling text, always check the official state or federal source. Not legal advice.
2. a. The Division of Medical Assistance and Health Services in the Department of Human Services shall provide coverage for an opioid antidote under the Medicaid program and the NJ FamilyCare program without the imposition of any prior authorization or other utilization management requirements, provided that the drug is:
(1)prescribed or administered to an enrollee by a licensed medical practitioner who is authorized to prescribe or administer that treatment pursuant to State and federal law; or
(2)dispensed to an enrollee 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. The division shall require each managed care organization contracted with the division to provide pharmacy benefits to Medicaid and NJ FamilyCare enrollees to comply with the provisions of this section.
d. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this section and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
e. As used in this section:
"Medicaid program" means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"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.
"NJ FamilyCare program" means the program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.).
L.2021, c.157, s.2.