52:14-17.29oo State Health Benefits Commission, HIV preexposure prophylaxis, HIV postexposure prophylaxis.
343 words·~2 min read·
/nj/title-52/chapter-14/52-14-17-29oo·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
12. a.
(1)Except as provided in paragraph
(2)of this subsection, the State Health Benefits Commission shall provide benefits to each person covered under the State Health Benefits Program for expenses incurred for HIV preexposure prophylaxis and HIV postexposure prophylaxis furnished without an individual prescription pursuant to the requirements of section 2 of P.L.2025, c.196 (C.45:14-67.13) without requiring prior authorization or step therapy.
(2)If the federal Food and Drug Administration has authorized or approved one or more therapeutic equivalents of a drug, device, or product for the prevention of HIV and AIDS, paragraph
(1)of this subsection shall not be construed to require the contract to cover all therapeutically equivalent versions without prior authorization or step therapy, if at least one version is covered without prior authorization or step therapy.
b. The State Health Benefits Commission shall not:
(1)prohibit, or permit a delegated pharmacy benefits manager to prohibit, a pharmacist from dispensing HIV preexposure prophylaxis or HIV postexposure prophylaxis; and
(2)be required to cover HIV preexposure prophylaxis that has been furnished by a pharmacist without an individual prescription pursuant to pursuant to section 2 of P.L.2025, c.196 (C.45:14-67.13) in excess of a 90-day supply for a single patient within a given two year period.
c. Nothing in this section shall be construed to require the State Health Benefits Commission to provide coverage for HIV preexposure prophylaxis or HIV postexposure prophylaxis furnished by a pharmacist at an out-of-network pharmacy, unless the contract has an out-of-network pharmacy benefit.
d. The benefits shall be provided to the same extent as for any other medical condition under the contract.
e. As used in this section:
“HIV preexposure prophylaxis” means the same as that term is defined in section 1 of P.L.2025, c.196 (C.45:14-67.12).
“HIV postexposure prophylaxis” means the same as that term is defined in section 1 of P.L.2025, c.196 (C.45:14-67.12).
“Step therapy” means requiring that a lower-cost alternative to HIV preexposure prophylaxis or HIV postexposure prophylaxis be shown to have been ineffective as a condition of providing prescription benefits.
L.2025, c.196, s.12.