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, which must be granted under specific circumstances, such as when a required drug is contraindicated or 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 the publication of statistics regarding the approval and denial of exception requests on their websites. Furthermore, the Commissioner of Human Services is tasked with applying for necessary state plan amendments or waivers to implement these provisions effectively. The act is set to take effect for all relevant contracts and policies on January 1, 2026.