Lampitt, Vainieri Huttle, & Benson Bill to Protect Chronically Ill Patients from Losing Coverage for Critical Medications Clears Assembly Panel

(TRENTON) – Aiming to help patients with complex or chronic medical conditions or rare diseases continue to have access to vital medications, legislation sponsored by Assembly Democrats Pamela Lampitt, Valerie Vainieri Huttle and Daniel Benson was approved Monday by an Assembly panel.

The bill (A-1858) would require health insurance carriers to cover prescriptions for patients who are denied coverage of a previously prescribed drug and choose to appeal the change in their plan. Such medications would be covered during the appeal process.

Patients protected under the bill would include those with conditions that do not have a known cure or can be severely debilitating or fatal if left untreated or undertreated. The same protections would be required for rare diseases affecting less than 200,000 people in the United States.

“Many patients who are suffering from a chronic medical condition find themselves in the lurch when health insurers stop carrying the medicine they need to manage their disease or illness,” said Lampitt (D-Camden, Burlington). “This legislation will help ensure patients with a chronic medical condition receive the medicine they need to live their best lives.”

“Many times a health insurance carrier will stop providing coverage for a medication but still cover a generic, sometimes less effective form,” said Vainieri Huttle (D-Bergen). “Patients who suffer from daily symptoms of chronic illness should have a choice whether to continue the medication that works for them and not have to settle for a generic brand that may not work.”

The bill also would require hospital, medical and health service corporations, commercial insurers, health maintenance organizations, health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs, prepaid prescription service organizations, and plans provided by the State Health Benefits Commission and the School Employees’ Health Benefits Commission to provide continued coverage of a prescription drug for a complex or chronic medical condition or rare disease when the drug:

(1) was previously covered by the carrier; and

(2) the prescribing provider continues to prescribe the drug for the medical condition or disease, provided the drug is appropriately prescribed, and the United States Food and Drug Administration (USFDA) has not indicated usage should cease.

“When a patient finds a medication that works for them, they should have the option to continue that medication without interruption,” said Benson (D-Mercer, Middlesex). “A patient shouldn’t have to worry whether or not their health insurance carrier will pay for the medication they need to live a healthier and happier life.”

The bill would further provide that a carrier shall not set forth limitations on maximum coverage of prescription drug benefits; subject the covered person to increased out-of-pocket costs; or move a drug for a covered person to a more restrictive tier, if the carrier uses a formulary with tiers.

The bill would take effect on the 90th day next following enactment.

The Assembly Financial Institutions and Insurance Committee approved the bill. It will now go to the Assembly Speaker for further consideration.