New Jersey § 26:2s-37

§ 26:2s-37.

a. Subject to subsection b. of this section and to the extent consistent with clinical

guidelines, the Commissioner of Banking and Insurance shall require carriers to provide

coverage of prescription drug refills even when the covered person has not yet reached

the scheduled refill date, provided that the prescription itself would remain valid

beyond the refill date and the member will be eligible beyond the refill date, in

a manner calculated to ensure a subscriber's ability to maintain at least a 30-day

supply, or a 90-day supply of a maintenance medication supply at home but not to exceed

a 120-day supply on-hand at any given time. The coverage shall be provided based on the authorization for the most recently

filled prescription and additional authorization for the refill shall not be required. b. The provisions of this section shall be in effect if: (1) a state of emergency or public health emergency is declared by the State or federal

government, or an emergency supply of a drug is recommended by the Centers for Disease

Control and Prevention; and (2) the commissioner determines that an emergency supply of prescription drugs is

necessary. c. The coverage shall be provided on an in-network basis to the same extent as for

any other refills of prescription drugs under the health benefits plan, except that: (1) in the event of a drug shortage or access issue identified by the commissioner

or the Division of Consumer Affairs, the carrier shall provide formulary flexibility

for a covered alternative. The cost-sharing for any non-preferred medication shall not exceed the cost-sharing

that would be imposed for the preferred medication that is unavailable due to the

shortage or access issue; and (2) no fees shall be imposed for home delivery of the drugs. d. The Division of Consumer Affairs, in consultation with the commissioner, may develop

restrictions on the filling or refilling of prescriptions by pharmacists to address

shortage concerns, provided those restrictions shall exclude restricting use for existing

conditions to the maximum extent practicable. e. As used in this section, “ carrier ” means an insurance company, health service corporation, hospital service corporation,

medical service corporation, or health maintenance organization authorized to issue

health benefits plans in this State, and shall include the State Health Benefits Program

and the School Employees' Health Benefits Program.