Committee releases bill aimed at preventing coverage gaps for maintenance medications
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Summary
The Financial Institutions and Insurance Committee amended and released AB434, which would prohibit certain state plans from denying maintenance medications solely because of changes in plan or pharmacy benefit manager. Health-plan representatives sought clarifying amendments to limit the mandate to clinically stabilized patients.
The committee amended and released Assembly Bill 434, which would prohibit the state health benefits program, the school employees health benefits program and Medicaid from denying coverage for maintenance medications for chronic conditions solely because of a change in health benefit plan or pharmacy benefits manager.
Alex Arnold of the New Jersey Association of Health Plans testified he supports continuity of care goals but asked for targeted amendments. Arnold said the bill as written would require continued coverage regardless of clinical context, potentially covering newly prescribed medications or medications during therapy transitions without clinical safeguards. He suggested aligning any requirement with recent prior-authorization frameworks that allow a 180-day transition for clinically stable patients and urged clarifying Medicaid-contract interactions.
The committee recorded supporters from independent and community pharmacy groups, moved to release the bill and announced it had been released on a roll-call vote. Members signaled intent to pursue technical clarifications during drafting and oversight.