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