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Conaway & Benson Bill Requiring Health Insurance Coverage of Pain Medication Approved by Assembly Panel
(TRENTON) - An Assembly panel has approved legislation sponsored by Assembly Democrats Herb Conaway, Jr., M.D. (D-Burlington) and Daniel Benson (D-Mercer/Middlesex) that would ease access to prescription pain medication for patients who need it by requiring certain health insurance providers to cover prescription pain medication.
The bill, which was approved by the Assembly Appropriations Committee, last month, addresses the shortcomings of "step therapy" or "fail first" policies. Step therapy is the health insurance industry practice of having patients try less-expensive alternative medications before insurance companies will pay for the pain treatment initially prescribed by a doctor.
"The purpose of step therapy is to control costs and minimize risks, but for some patients, this method does not work," said Conaway. "To deny coverage for pain medication that has been prescribed by a doctor as the most effective way to alleviate a patient's pain is cruel. This bill puts the patient's well-being first and ensures they are able to get the medication they need when they need it."
"Telling patients that they cannot get the best pain medication available until they try a series of cheaper versions disregards the advice of their doctors and denies patients immediate relief," said Benson. "Treatment decisions should be made by physicians, not insurance companies."
The bill (A-1832) requires certain health insurers, under every policy or contract that provide coverage for outpatient prescription drugs, to provide coverage for prescription drugs used to treat pain in accordance with its provisions. The bill applies to the following: health, hospital and medical service corporations; commercial individual and group health insurers; health maintenance organizations; the State Health Benefits Program; and the School Employees' Health Benefits Program.
Under the bill, if the insurer or program, in its policy or contract, restricts coverage for medications for the treatment of pain pursuant to a step therapy or fail-first protocol, the following provisions must be adhered to:
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