New Jersey health plans would cover certain mental illness drugs without prior approval

Health insurers and the state Medicaid and NJ FamilyCare programs would cover qualifying prescription drugs without prior approval or other plan management rules, including step therapy. The rule applies only to people age 18 or older. Insurance coverage lists schizophrenia, schizo-affective disorders, bipolar disorders, major depressive disorders, and post-traumatic stress disorder. Medicaid and NJ FamilyCare also list childhood and adolescent depression, obsessive compulsive disorders, and paranoid and other psychotic disorders. For insurance coverage, the prescriber must be a psychiatrist or, during the postpartum period, an obstetrician/gynecologist. After six months of stable and appropriate treatment with a drug prescribed by one of those providers, another prescriber may continue it without these plan rules. For Medicaid and NJ FamilyCare, the prescriber must be a licensed practitioner authorized to prescribe the treatment and must meet the same psychiatrist or postpartum obstetrician/gynecologist rule. The state must require contracted managed care organizations that provide pharmacy benefits to follow the rule. The act would take effect on the 180th day after enactment. The insurance provisions would apply to policies issued or renewed on or after that effective date; no separate application date is stated for Medicaid and NJ FamilyCare.