This bill mandates that health insurance carriers, as well as 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 a serious mental illness for six months, another prescriber may continue the medication without prior authorization. The provisions of this bill apply only to individuals aged 18 and older. The bill aims to enhance access to necessary medications for individuals suffering from serious mental health conditions, thereby promoting better health outcomes and reducing barriers to treatment.

Statutes affected:
Introduced: 26:2S-10.8