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Bill

A 1510

Improves access to lower-cost generic and biosimilar drugs.

2026-2027 Regular Session Introduced by Roy Freiman and 1 co-sponsor

The bill requires plans to prioritize cheaper generics and biosimilars on formularies, ban barriers to access, and publish transparent, up-to-date formulary information to lower co

Reported out of Assembly Comm. with Amendments, 2nd Reading
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Bill Summary · A 1510

Overview

A 1510, from the 222nd New Jersey Legislature, seeks to improve access to lower-cost generic and biosimilar drugs for public health benefits programs and Medicaid. The bill establishes policies for formulary placement, cost-sharing advantages, and transparency around drug lists. It takes effect January 1, 2027 and applies to contracts and policies issued or renewed on or after that date.

main purpose and intent

  • Promote the use of lower-cost alternatives (generics and biosimilars) when available.
  • Ensure brand drugs are displaced by cheaper equivalents for patients who have not previously taken the prescribed brand.
  • Increase transparency of formularies and track cost-sharing opportunities to reduce out-of-pocket costs for enrollees.

Key provisions and changes

  • Definitions (section 1): Clarifies terms for biosimilar, brand drug, generic drug, reference listed drug/product, managed care organizations, covered person, health benefits plan, and wholesale acquisition cost (WAC).

  • Preference for biosimilars and generics (sections 2, 11, 13, 14):

    • If a brand drug or a biosimilar/generic has a lower WAC than the reference drug/product on its initial marketing date, the plan must place the cheaper option on the formulary with more favorable cost sharing.
    • No prior authorization, step therapy, or other restrictions should be imposed that would hinder access to the lower-cost alternative relative to the reference product.
    • The cheaper generic or biosimilar must remain on the formulary so long as its WAC remains lower than the reference.

  • Formulary transparency and accessibility (sections 3, 12):

    • Managed care organizations and vendors must publish and maintain an up-to-date, accurate formulary list, including tiering and restrictions.
    • Formulary information must be easily accessible on public websites without account requirements; updates within 30 days of changes, with the update date in bold.

  • Applicability to programs (sections 3, 12; with parallel sections for vendor and state Medicaid lines):

    • Applies to the State Health Benefits Program, School Employees’ Health Benefits Program, and the State Medicaid program.
    • Vendors and managed care organizations covered by these programs must adhere to formulary transparency and favorable cost-sharing requirements.

  • Appeals (sections 2, 11):

    • Healthcare providers may appeal the default biosimilar/generic preference requirement for individual patients under specified statutory processes.

  • Limitations (sections 6, 7, 15, 16, 17):

    • A vendor or plan is not required to continue coverage of a brand drug after a generic or biosimilar is approved and marketed if not medically appropriate or cost-effective.
    • Provisions do not override pharmacist practice requirements.

  • Implementation and rulemaking (sections 9, 18):

    • DHS and the Department of Banking and Insurance must adopt regulations to implement the act's provisions.

Who is affected

  • Enrollees in:
    • State Health Benefits Program
    • School Employees’ Health Benefits Program
    • State Medicaid program
  • Managed care organizations overseeing these programs
  • Pharmacy benefit vendors and third-party administrators
  • Healthcare providers (through appeals process)

Timeline and process

  • Effective date: January 1, 2027
  • Applies to contracts, policies, and vendor formularies issued, delivered, or renewed on or after that date.
  • Regulatory rules to be issued under the Administrative Procedure Act by relevant state agencies.

Potential impact

  • Increased uptake of generics and biosimilars, potentially lowering patient out-of-pocket costs.
  • More transparent and publicly accessible formulary information.
  • Faster formulary changes to accommodate lower-cost alternatives within 30 days of updates.
  • Clinician appeals preserved to tailor treatment to individual patients when needed.

Compiled from official sources — confirm details with the bill’s official record.

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