By Vin Gopal

Getting the right medications to people who have been diagnosed with a serious mental illness in a timely fashion is critical to effective treatment.

By Vin Gopal

Getting the right medications to people who have been diagnosed with a serious mental illness in a timely fashion is critical to effective treatment.

That’s why Senator Raj Mukherji and I have sponsored legislation to require prescription drug coverage for serious mental illness without prior authorization, including step therapy. The latter is a process by which public or private insurers require patients to take one or more “alternative” medications, often generics, before they can access the medicine prescribed by their own doctor. 

Now before the Senate Budget and Appropriations Committee, the bill would supplement another of our bills that the governor signed into law in January updating and streamlining the requirements and standards for prior authorization. That was an important step to speeding up the prior authorization process. Our new bill is an important and logical next step to help the 248,000 adults in New Jersey with serious mental illness (as of February 2021, according to the National Alliance on Mental Illness.) 

Under our bill, health insurance companies and the state Medicaid and NJ Family Care programs would be required to cover the cost of prescription drugs for serious mental illnesses, including schizophrenia and major depressive disorders, without requiring prior authorization or “step therapy” protocols. The bill covers a wide range of serious mental illnesses including depression in childhood and adolescence, schizophrenia and bipolar disorders, major depressive and obsessive compulsive disorders.

Prior authorization is a useful tool for ensuring that patients are not prescribed the wrong medication or services. But step therapy policies can create problems for patients because it requires them to try treatments because they are cheaper, but not necessarily for medical reasons. As a result some patients are forced to take the regimen of medication that fails before the insurer allows them to switch to the one their doctor originally prescribed. Our legislation preserves the direct decision-making relationship between the patient and their physician about the best course of treatment. 

Ensuring that everyone has access to healthcare is a top priority for our Legislative District 11 team, including Assemblywomen Dr. Margie Donlon and Luanne Peterpaul. We also have sponsored legislation to ensure that insurance coverage keeps pace with an important innovation in cancer treatment - biomarker testing - to help diagnose and prescribe the most effective treatments.

 It’s gratifying to report that a number of our healthcare bills have progressed in the state legislature this year.

In addition to our prior authorization bill, the governor has signed into law our pay parity legislation, requiring insurers to pay providers of telehealth at the same rates as in-person treatment. 

In an effort to address the shortage of volunteer first responders, the LD11 legislative team also introduced a new package of bills to provide incentives for the recruitment and retention of volunteer first responders. The legislation, comprising three bills, would provide tuition credits, partial property tax exemptions, and gross income tax credits to qualifying volunteer first responders.

We also have sponsored legislation to create a sustainable source of funding for local health departments by requiring a minimum annual state appropriation of $10 million for public health priority funding. The bill, which has bipartisan support, has been referred to the Senate Health, Human Services and Senior Citizens Committee, and the Assembly Health Committee. It would make funding available to any of the approximately 105 local health departments in the state.