[{"_1":2,"_100":-5,"_101":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6077042,"mediaKeyId","2966049-79778cffac6768e7ec703b983b92b283","parentId",2966049,"title","Committee amends and releases bill to limit prior authorization for some drugs treating serious mental illness","audioSeconds",1348,"startMs",5114000,"endMs",6462000,"viewUrl","/Search/View?dp=1&key=2966049-79778cffac6768e7ec703b983b92b283&start=5114&end=6462","thumbnailUrl","https://assets.pipeline.soar.com/2966049-79778cffac6768e7ec703b983b92b283/thumbnail_5114000.jpg","articleUrl","/articles/6077042/New-Jersey/Committee-amends-and-releases-bill-to-limit-prior-authorization-for-some-drugs-treating-serious-mental-illness","mediaUrl","https://secure.pipeline.soar.com/6077042-beb1c468e6d05ede24c234f2a96a9d98/orig.mp4?Expires=1771191794&Signature=NNJekN8~gD5creardVD3f3glry0~tG~9kB0cWw95uXoEH~TSyw98Y8eZjxKdPhAmajbhxW8TiNmCCdryS-ckJKztYoMsO4a4VGnn0Pex0421~RIbqjueuC2MtxifvE6OL2i0BiyhIVvvDNHnwgTbKxfntpJI~NuDdXPrXzjBJ5PKBj6bbZiV8TG3bTSprsjwymOZMi6yxXxpFifvgJ6TzNa3jZab2s4hNYTzYIaFtmLwA99zDD-K4tMy7tRKY7IL4~01gxOC-mCU8jllef84VL0zB3rgTeV6DHjtQ0CTklyYhrqICXIBiz7GfwsuEPGAQaqQmA1j2M2fR1mOpplrdg__&Key-Pair-Id=KUT5TJCACFTXG","author","New Jersey Legislature","date","2025-04-10T00:00:00Z","article","The Assembly Health Committee amended and released Assembly Bill 4838, which would require coverage of prescription drugs for serious mental illness without prior authorization or utilization management — with committee amendments that narrow the requirement to prescriptions written by psychiatrists (and obstetricians/gynecologists during the postpartum period) and to adults aged 18 or older.

Sponsors said the change is intended to remove barriers and accelerate access to medications for people with serious mental illness. ‘‘When we put forth legislation that has to do with mental health… when it comes to saving any lives, I don’t think we should put any barriers to seeking anything that we can do to prevent the loss of life,’’ Assemblywoman Pagoli said during sponsor remarks.

Health‑plan representatives and industry groups testified in opposition or asked clarifying amendments. Ward Sanders of the New Jersey Association of Health Plans said the bill, as originally written, would affect Medicaid, the state health benefits program and commercial markets and could remove ‘‘safety edits’’ plans use to check potentially dangerous combinations or misuse of powerful medications. Sanders also noted the state recently enacted legislation, effective Jan. 1, 2025, intended to streamline prior authorization, and he urged caution about removing utilization management entirely.

Committee members questioned the tradeoffs between removing delays for patients in crisis and the fiscal exposure to state programs. Witnesses and members discussed prior authorization reform recently enacted at the state level, the separate pending step‑therapy bill, and exceptions that would allow a prescriber to continue a drug after six months if the patient is stable and the prescriber changes.

During roll call for the committee motion to amend and release the bill, at least one member publicly expressed concern about the fiscal impact and abstained; another member explicitly voted no citing state fiscal risk from federal Medicaid funding uncertainty. The committee nevertheless approved the amended bill and released it for further action.

Ending: Assembly Bill 4838 was amended to narrow its scope (psychiatrist‑prescribed drugs and postpartum OB/GYN prescriptions; adults only) and released by committee. Staff were asked to provide fiscal impacts and coordinate with sponsors and stakeholders on implementation details and safety‑edit language.

","mediaType","Video","parentTitle","Assembly Financial Institutions and Insurance Thursday, April 10, 2025 - 10:00 AM","oneSentenceSummary","Assembly Bill 4838 was amended and released after testimony and debate. Sponsors argued removing prior authorization and step therapy for certain prescriptions would speed access to care for people with serious mental illness; health‑plan representatives warned of higher program costs and loss of safety edits.","taxTitle","2025 Legislative Sessions, New Jersey","taxId",77696,"location","New Jersey","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6077047,"Assembly committee advances bill to require insurance coverage for stuttering treatment after testimony from advocates and clinicians",1657,3227000,4884000,"/Search/View?dp=1&key=2966049-79778cffac6768e7ec703b983b92b283&start=3227&end=4884","https://assets.pipeline.soar.com/2966049-79778cffac6768e7ec703b983b92b283/thumbnail_3227000.jpg","/articles/6077047/New-Jersey/Assembly-committee-advances-bill-to-require-insurance-coverage-for-stuttering-treatment-after-testimony-from-advocates-and-clinicians","https://secure.pipeline.soar.com/6077047-4c80f5fbe115234f8293f0c654b4e7d1/orig.mp4?Expires=1771191794&Signature=GpK0~G8nxhGQ6s335UsI5q-TAQPyyViDodyfi2eCelklv3F1q7Ud0~Xiw-himsRmH39QZdxwYM7CVtpcZLHXa4xmMSdadEXSg-DOPp~fmSbrlMprx5GWEGdDEvpSfGug9~wWkUjaUGobnM3pmaePOTyl47Xvj2izNsDn3DifDS9BjFAVU4kl1NczLsGEQMe1TFxoEZRSiQM5koXexxLm573volC0w9mj~M6B69zGPouQJ5nttKW96l0Yh9rpkL9TAf2dt0xibUyJ0XgDeE9joEbdEtsuuFxwD9eoyKe9yhLOK54kHs-vK~bStH9ilekrhuBesrOdkU6bmsN1mD6YMg__&Key-Pair-Id=KUT5TJCACFTXG","The New Jersey Assembly Health Committee amended and released Assembly Bill 5133 on a motion during its session after advocates, clinicians and family members testified in favor of requiring health insurance and Medicaid coverage for treatment of stuttering.

Advocates including former NBA player Michael Kidd‑Gilchrist and two youth advocates described personal and educational impacts of stuttering and urged coverage beyond school-based services. ‘‘For us who stutter as adults and as kids at times, it’s very, very hard and challenging… I see this as me just putting an effort and time into my own state,’’ Michael Kidd‑Gilchrist said while urging support for the bill.

Celeste Domch, a speech‑language pathologist and associate professor at Rutgers, testified on clinical evidence and outcomes. Domch said stuttering typically emerges in preschool and that ‘‘a 4‑year‑old who receives appropriate speech therapy has a 75 percent chance of recovering from stuttering,’’ adding that therapy improves school participation, self‑confidence and long‑term outcomes. Domch emphasized that school‑based services (IEP/504) can address some needs but do not always generalize to communication outside school and that gaps exist for preschoolers and adults who no longer qualify for school services.

Supporters said the bill would remove barriers created by insurance exclusions and session caps, and provide coverage when families do not qualify for or cannot access school‑based therapy. Witnesses described limits on session counts and lifetime caps under some plans and urged coverage to enable early intervention and continued treatment into adulthood when needed.

Representatives from health plans and the New Jersey Association of Health Plans sought technical amendments and emphasized program design issues. Ward Sanders, representing health plans, said proposed committee amendments addressed many technical concerns; he noted that coverage definitions differ across the state health benefits program, Medicaid and commercial plans and asked sponsors to clarify benefit design and interaction with existing school services.

On the committee floor members praised the testimony from young advocates and clinicians. Several members said the bill addresses real gaps in care; one member raised concerns that school systems should improve early identification and services but supported the bill as an important safety net.

The committee approved the motion to amend and release Assembly Bill 5133. The record shows a majority of committee members voting in the affirmative after discussion; one member publicly announced an abstention during the roll call.

Ending: The bill was amended and released from committee; sponsors and staff will reconcile technical amendments related to benefit definitions, provider scope and interaction with school‑based services before further legislative action.","The committee amended and released Assembly Bill 5133, which would require health insurers and Medicaid to cover treatment for stuttering. Testimony from adult and youth advocates and a Rutgers speech‑language pathologist emphasized early treatment’s benefits; health plan representatives sought technical clarifications.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6077052,"Experts tell Assembly panel PBM structure can raise drug prices, call for transparency and incentive reform",6607,273000,6880000,"/Search/View?dp=1&key=2966049-79778cffac6768e7ec703b983b92b283&start=273&end=6880","https://assets.pipeline.soar.com/2966049-79778cffac6768e7ec703b983b92b283/thumbnail_273000.jpg","/articles/6077052/New-Jersey/Experts-tell-Assembly-panel-PBM-structure-can-raise-drug-prices-call-for-transparency-and-incentive-reform","https://secure.pipeline.soar.com/6077052-2e3bba6439d270de2b3543fcb12bad56/orig.mp4?Expires=1771191794&Signature=QNpOoQy-KUk05ufxDaqGAmyEMLxhsgsU0sYrD2lGV3k4kVnqApOKimDOeJQONzPQxmm~fL04C89Ir5bvq~qz2H5NqPpM2FWWNFmQ3APlHBDfMPLSHkCTQL96wb9F4PLJ-yztVIVh-XkJVNJi3gfsajGxzZVINX3VIqfuHpMfiJXxxjUKLsAhtiwir2coc-T47-dZA7ZZOxaf4cvkJvgLNlCewofRTuIsO0WK5uqqeXwKpInsu4vMvOpFrmjVsTwc9fQigFGTklQm059h3KagjEuAwy6K3sp94CXoIZTrXrES3CPrD-yNj7PlaipUsmmG9bC6qwlt86ahllzL6uvmKA__&Key-Pair-Id=KUT5TJCACFTXG","Two university professors told the New Jersey General Assembly Health Committee that pharmacy benefit managers, or PBMs, are an important but opaque intermediary in the U.S. prescription drug market and that current incentives can raise costs for patients and payers.

PBMs bundle purchasing power and negotiate discounts with drug manufacturers, but ‘‘the more obscure’’ their contracts are, the more likely consumers pay too much, Rutgers law professor Michael Carrier told the committee. Carrier added that PBMs can favor brand or higher-priced formulations when manufacturers give larger rebates, and that consolidation among PBMs gives three large firms overwhelming market power.

The question of how PBMs affect prices matters because the apparent retail price of a drug often differs sharply from the amount manufacturers and patients actually pay. ‘‘The formulary is the list of drugs that the patient is able to take. That should be based on determinations of what is the best drug, what is the most cost effective treatment. It should not be given to a brand firm that happens to give a lot of money to the PBM,’’ Carrier said. He cited examples where a slightly discounted branded product occupied a preferred formulary position over a deeply discounted biosimilar because the brand paid larger rebates.

Professor Jeffrey Joyce of the University of Southern California presented empirical data backing the concern about opacity in the distribution chain. Joyce said national outpatient prescription spending in recent years shows a large ‘‘wedge’’ between list prices and net prices after discounts, and that intermediaries take a sizable share of that wedge. He said roughly one-third of current outpatient prescription spending flows to intermediaries and distribution rather than to manufacturers or consumers. Joyce summarized his view: ‘‘PBMs serve a very valuable role of claims administration…and their main function is as a group purchasing organization. There are two caveats: they retain too much of the savings… and they create perverse incentives where everyone in the supply chain prefers a highly rebated, high-cost drug over a lower-cost alternative.’’

Committee members pressed witnesses on specifics the legislature could address. Members and witnesses discussed: (1) closed versus open formularies (New Jersey law prevents closed formularies, the panel heard), (2) the design and effect of rebate pass-through laws that require rebates to go to plans or point-of-sale, and (3) the impact of vertical consolidation (PBMs owning insurers, retail pharmacies, and specialty/mail-order pharmacies).

Carrier and Joyce both recommended reforms that preserve PBM functions while changing financial incentives: require greater transparency of rebate and reimbursement flows; delink PBM compensation from list prices; and require fiduciary duties or fixed, auditable administrative fees rather than profit shares tied to the price of a drug. Joyce suggested a fixed administrative fee per claim plus outcome or cost-growth bonuses as an alternative to percentage-based payments tied to list prices.

The committee’s discussion also touched on policy tradeoffs. Witnesses and members agreed that some PBM activity produces savings for large purchasers and that manufacturers’ net prices matter for future investment in drug development. At the same time, the witnesses argued the current opaque mix of list prices, rebates, and post-sale clawbacks can harm uninsured patients and beneficiaries who face cost sharing based on list prices.

The exchange underlined several recurring themes for lawmakers: requiring clearer accounting for rebate flows, strengthening audit rights for plan sponsors, and considering statutory limits on PBM practices such as certain forms of spread pricing or ownership-driven pharmacy steering. Lawmakers also flagged outstanding questions for staff follow-up, including local data on pharmacy closures and precise fiscal estimates of particular reforms.

The committee did not take formal action on PBM-specific legislation at the hearing; members and the two academic witnesses agreed more detailed, evidence-based proposals would be required before drafting binding statutory changes.

The committee later received and debated two separate bills (coverage for stuttering treatment and changes to prior authorization for serious mental illness), which were handled as distinct agenda items.

Ending: The PBM presentations generated substantial committee interest and follow-up requests for data. Both professors recommended transparency and incentive changes; the committee asked staff to compile fiscal impacts and state-specific information for future deliberations.","Two academics told a New Jersey Assembly committee that pharmacy benefit managers (PBMs) play a central and opaque role in drug pricing, favoring high-rebate drugs and keeping a sizable share of negotiated discounts. Witnesses recommended disclosure, clearer incentives and statutory guardrails to protect patients and payers.","actionData","errors"]

Article not found

Committee amends and releases bill to limit prior authorization for some drugs treating serious mental illness

Assembly committee advances bill to require insurance coverage for stuttering treatment after testimony from advocates and clinicians

Experts tell Assembly panel PBM structure can raise drug prices, call for transparency and incentive reform