This bill mandates that health insurance carriers and the State Medicaid and NJ FamilyCare programs provide coverage for prescription drugs prescribed for serious mental illnesses without requiring prior authorization or any form of utilization management, including step therapy protocols. The bill defines "serious mental illness" to include specific psychiatric conditions such as schizophrenia, schizo-affective disorders, major depressive disorders, and post-traumatic stress disorder, as outlined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders. Coverage is specifically required when the prescription is made by a psychiatrist or an obstetrician/gynecologist during the postpartum period. Additionally, if a patient has been stable on a prescribed medication for six months, another prescriber may continue that medication without prior authorization.

The bill also stipulates that these provisions apply only to individuals aged 18 and older. It requires managed care organizations contracted with the Division of Medical Assistance and Health Services to comply with these coverage requirements. The legislation aims to enhance access to necessary medications for individuals suffering from serious mental illnesses, thereby promoting better mental health outcomes without the barriers of prior authorization or utilization management. The bill will take effect 180 days after enactment and will apply to policies issued or renewed thereafter.

Statutes affected:
Introduced: 26:2S-10.8