This bill establishes new 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, which must be granted if the prescribing healthcare provider determines that the required drug is contraindicated, ineffective, or has caused adverse reactions.

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 by multidisciplinary panels and be based on high-quality studies and objective data. Furthermore, it mandates that statistics regarding the approval and denial of step therapy exception requests be made publicly available. The act is set to take effect on January 1, 2026, applying to all relevant contracts and policies issued or renewed after that date.