This bill establishes regulations regarding step therapy protocols used by health insurance carriers and managed care organizations in New Jersey. It emphasizes the importance of basing these protocols on appropriate clinical practice guidelines or peer-reviewed data developed by independent experts. The legislation mandates that patients be exempt from step therapy protocols when they are deemed inappropriate or not in the best interest of the patient. Additionally, it ensures that patients have access to a transparent process for requesting exceptions to these protocols, particularly when their healthcare provider determines that the required medication may cause harm or is ineffective.

The bill also outlines the responsibilities of managed care organizations and vendors in providing clear processes for step therapy exception requests, including timely responses to these requests. It requires that clinical review criteria for step therapy protocols be developed transparently and reviewed regularly to minimize biases. Furthermore, the bill mandates that statistics regarding the approval and denial of step therapy exceptions be made publicly available. The provisions of this act will take effect for all relevant contracts and policies on or after January 1, 2026.