This bill establishes guidelines for step therapy protocols used by the State Health Benefits Program (SHBP), the School Employees Health Benefits Program (SEHBP), and Medicaid in New Jersey. It emphasizes the importance of basing these protocols on clinical practice guidelines developed by independent experts and mandates that patients be exempt from step therapy when it is deemed inappropriate for their individual needs. The bill also requires that patients have access to a transparent process for requesting exceptions to step therapy protocols, ensuring that healthcare providers retain the right to make medically necessary treatment decisions in the best interest of their patients.

Key provisions include the requirement for managed care organizations and vendors to provide clear processes for requesting step therapy exceptions, which must be granted under specific circumstances, such as when a prescribed drug is contraindicated or ineffective. The bill mandates that any granted exceptions be valid for at least 180 days and allows for appeals of exception requests. Additionally, it requires the disclosure of clinical review criteria and statistics regarding exception requests on the organizations' websites. The act is set to take effect on January 1, 2026, applying to all relevant contracts and policies issued or renewed thereafter.