N.J.S.A. 52:14-17.28i — Clinical review criteria, guidelines, step therapy protocol, State Health Benefits Commission, School Employees' Health Benefits Commission.

52:14-17.28i Clinical review criteria, guidelines, step therapy protocol, State Health Benefits Commission, School Employees' Health Benefits Commission. 8. a. A contract entered into by the State Health Benefits Commission or the School Employees' Health Benefits Commission with a vendor shall require that clinical review criteria used to establish a step therapy protocol are based on clinical practice guidelines developed by the vendor that: (1) recommend that the prescription drugs be taken in the specific sequence required by the step therapy protocol; (2) are developed and endorsed by a multidisciplinary panel of experts that: (a) relies on objective data; and (b) manages conflicts of interest among the members by requiring members to disclose any potential conflict of interests with entities, including vendors, carriers, and pharmaceutical manufacturers, and recuse themselves from voting if they have a conflict of interest; (3) are based on high-quality studies, research, and medical practice; (4) are created by an explicit and transparent process that: (a) minimizes biases and conflicts of interest; (b) explains the relationship between treatment options and outcomes; (c) rates the quality of the evidence supporting recommendations; and (d) considers relevant patient subgroups and preferences; and (5) are reviewed annually or quarterly if there is a new indication or new clinical information available and updated when such review reveals new evidence necessitating modification. b. In the absence of clinical guidelines that meet the requirements in subsection a. of this section, peer-reviewed publications may be substituted. c. When establishing a step therapy protocol, a utilization review agent shall also consider the needs of atypical patient populations and diagnoses when establishing clinical review criteria. d. A vendor shall: (1) upon written request, provide written clinical review criteria relating to a particular condition or disease, including clinical review criteria relating to a step therapy protocol exception determination; and (2) make available the clinical review criteria and other clinical information on its Internet website and to a health care professional on behalf of an insured person upon written request. e. This section shall not be construed to require vendors or the State to establish a new entity to develop clinical review criteria used for step therapy protocols. L.2025, c.50, s.8.

This is the verbatim text of N.J.S.A. 52:14-17.28i, 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.