N.J.S.A. 17:48E-35.51 — Group, individual health service corporation contracts, HIV preexposure prophylaxis, HIV postexposure prophylaxis.

17:48E-35.51 Group, individual health service corporation contracts, HIV preexposure prophylaxis, HIV postexposure prophylaxis. 5. a. (1) Except as provided in paragraph (2) of this subsection, no group or individual health service corporation contract providing hospital or medical expense benefits shall be delivered, issued, executed, or renewed in this State or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, unless the contract provides benefits to any subscriber or other person covered thereunder for HIV preexposure prophylaxis and HIV postexposure prophylaxis furnished without an individual prescription pursuant to the requirements of section 2 of P.L.2025, c.196 (C.45:14-67.13) without requiring prior authorization or step therapy. (2) If the federal Food and Drug Administration has authorized or approved one or more therapeutic equivalents of a drug, device, or product for the prevention of HIV and AIDS, paragraph (1) of this subsection shall not be construed to require the contract to cover all therapeutically equivalent versions without prior authorization or step therapy, if at least one version is covered without prior authorization or step therapy. b. Reimbursement issued under this section to a pharmacist shall be at a rate that is no less than the rate provided by the group or individual health service corporation contract to other non-physician practitioners if the reimbursement is for a service or procedure that meets the following criteria: (1) the service or procedure is within the scope of practice of the treating pharmacist; and (2) the service or procedure would otherwise be covered under the contract if provided by a healthcare provider, including a physician, advanced practice nurse, or physician assistant. c. A contract offered by a group or individual health service corporation shall grant a licensed pharmacist receiving reimbursement under this section the same rights of participation, plan admission, and registration as may be granted by the contract to a healthcare provider, including a physician, advanced practice nurse, or physician assistant, who is reimbursed for an identical service. d.A contract offered by a group or individual health service corporation shall not: (1) prohibit, or permit a delegated pharmacy benefits manager to prohibit, a pharmacist from dispensing HIV preexposure prophylaxis or HIV postexposure prophylaxis; and (2) be required to cover HIV preexposure prophylaxis that has been furnished by a pharmacist without an individual prescription pursuant to pursuant to section 2 of P.L.2025, c.196 (C.45:14-67.13) in excess of a 90-day supply for a single patient within a given two year period. e. Nothing in this section shall be construed to require a contract offered by a health service corporation to provide coverage for HIV preexposure prophylaxis or HIV postexposure prophylaxis furnished by a pharmacist at an out-of-network pharmacy, unless the contract has an out-of-network pharmacy benefit. f. The provisions of this section shall apply to all contracts in which the health service corporation has reserved the right to change the premium. g. As used in this section: �HIV preexposure prophylaxis� means the same as that term is defined in section 1 of P.L.2025, c.196 (C.45:14-67.12). �HIV postexposure prophylaxis� means the same as that term is defined in section 1 of P.L.2025, c.196 (C.45:14-67.12). �Step therapy� means requiring that a lower-cost alternative to HIV preexposure prophylaxis or HIV postexposure prophylaxis be shown to have been ineffective as a condition of providing prescription benefits coverage for the prophylaxis. L.2025, c.196, s.5.

This is the verbatim text of N.J.S.A. 17:48E-35.51, retrieved from the New Jersey Legislature's public statute corpus. Statutes are amended periodically — for the most current version, check the external source link above. Kyzer is not a law firm and this page is not legal advice.