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MD

Bill

A 1821

Prohibits health insurance carriers from denying coverage of nonopioid prescription drugs in favor of opioid prescription drugs.

2026-2027 Regular Session Introduced by Mitchelle Drulis and 6 co-sponsors

Prohibits denying nonopioid acute pain meds or forcing opioid trials, and ensures FDA-approved nonopioids are not disadvantaged in coverage, costs, or formularies.

Reported out of Assembly Committee, 2nd Reading
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Bill Summary · A 1821

Overview

A1821, introduced in the New Jersey 222nd Legislature, prohibits health insurance carriers from denying coverage of nonopioid prescription drugs for acute pain in favor of opioid drugs, and from requiring patients to try an opioid first. The bill also requires state health benefit programs to align with this standard and to avoid disadvantaging nonopioid options on formularies.

Main purpose and intent

  • To ensure that when a licensed health care provider prescribes a nonopioid medication for acute pain, insurers do not:

    • Deny coverage in favor of an opioid prescription, and
    • Require a patient to try an opioid before approving a nonopioid.

  • To guarantee nonopioid pain medications approved by the FDA are not disadvantaged or discouraged relative to opioids in terms of coverage decisions, cost-sharing, and other formulary controls.

Key provisions and changes

  1. General prohibition (acute pain, nonopioid vs. opioid):

    • Carriers cannot deny nonopioid prescriptions or require opioid trials before approving nonopioid use.
    • If a formulary exists, nonopioid FDA-approved pain medications must not be disadvantaged or discouraged compared to opioids, including:
      • Not imposing more restrictive coverage criteria on nonopioids than the least restrictive opioid criteria.
      • Not imposing stricter utilization controls (e.g., prior authorization, step therapy) for nonopioids relative to opioids.
      • Not placing nonopioids on cost-sharing tiers with higher requirements than the lowest-cost opioid tier.

  2. State Health Benefits Commission contracts (hospital/medical expense benefits):

    • Any new contracts (or renewals) after the act’s effective date must ensure nonopioid acute pain medications are not denied in place of opioids and that opioid-first requirements are not imposed.
    • Formularies must treat FDA-approved nonopioids no less favorably than opioids in coverage and cost-sharing.

  3. School Employees' Health Benefits Commission contracts:

    • Similar protections and formulary requirements apply to contracts it purchases.

  4. Medicaid provisions:

    • Department of Human Services must not deny Medicaid-covered nonopioid acute pain medications in favor of opioids and must ensure nonopioids on the preferred drug list are not disadvantaged versus opioids.

  5. Effective date:

    • Takes effect January 1, 2026, and applies to policies, plans, and contracts delivered, issued, executed, or renewed on or after that date.

Who would be affected

  • Commercial health insurance carriers in New Jersey.
  • State-level health benefit programs:
    • State Health Benefits Commission (state employee plans)
    • School Employees’ Health Benefits Commission
    • Medicaid program administered by the Department of Human Services
  • Providers prescribing nonopioid medications for acute pain to insured individuals.

Procedural/timeline aspects

  • Introduced and referred to committees in 2026, with a possible technical review by Legislative Counsel.
  • If enacted, the act would apply to contracts and policies issued or renewed on or after January 1, 2026.

Practical impact

  • Promotes greater access to nonopioid pain management options.
  • Aims to reduce barriers that could steer patients toward opioids due to coverage or cost-sharing practices.
  • Could influence formulary design and prior authorization policies across private plans and state-administered programs.

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

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