New Jersey § 30:4D-7uu Findings, declarations.

New Jersey Statutes

§ 30:4D-7uu — Findings, declarations.

New Jersey § 30:4D-7uu

Title 30INSTITUTIONS AND AGENCIES

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Bluebook

N.J. Stat. Ann. § 30:4D-7uu (2026).

Text

1.The Legislature finds and declares that: a. To address the increasingly high cost of prescription drug utilization and to address patient safety, health insurance carriers and other plan sponsors use step therapy protocols that require patients to try one or more prescription drugs before coverage is provided for a drug selected by the patient's health care provider.

b.Step therapy protocols, if based on well-developed scientific standards and administered in a flexible manner that takes into account the individual needs of patients, can play an important role in controlling health care costs.

c.Requiring a patient to follow a step therapy protocol may have adverse and even dangerous consequences for the patient, who may either not realize a benefit from taking a prescription drug or

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1. The Legislature finds and declares that: a. To address the increasingly high cost of prescription drug utilization and to address patient safety, health insurance carriers and other plan sponsors use step therapy protocols that require patients to try one or more prescription drugs before coverage is provided for a drug selected by the patient's health care provider. b. Step therapy protocols, if based on well-developed scientific standards and administered in a flexible manner that takes into account the individual needs of patients, can play an important role in controlling health care costs. c. Requiring a patient to follow a step therapy protocol may have adverse and even dangerous consequences for the patient, who may either not realize a benefit from taking a prescription drug or may suffer harm from taking an inappropriate drug. d. It is imperative that step therapy protocols in the State preserve the heath care provider's right to make medically necessary treatment decisions in the best interest of the patient. e. The Legislature declares, therefore, that it is a matter of public interest that the State Health Benefits Program, the School Employers Health Benefits Program, and NJ FamilyCare be required to base step therapy protocols on appropriate clinical practice guidelines or published peer-reviewed data developed by independent experts with knowledge of the condition or conditions under consideration; that patients be exempt from step therapy protocols when those protocols are inappropriate or otherwise not in the best interest of the patients; and that patients have access to a fair, transparent, and independent process for requesting an exception to a step therapy protocol when the patient's physician deems appropriate. L.2025, c.50, s.1.