New Jersey Statutes 52:14-17.46.6u. School Employees’ Health Benefits Commission, ensure, contract purchased, renewed, benefits, covered, expenses, prescription asthma inhaler
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Terms Used In New Jersey Statutes 52:14-17.46.6u
- Contract: A legal written agreement that becomes binding when signed.
- person: includes corporations, companies, associations, societies, firms, partnerships and joint stock companies as well as individuals, unless restricted by the context to an individual as distinguished from a corporate entity or specifically restricted to one or some of the above enumerated synonyms and, when used to designate the owner of property which may be the subject of an offense, includes this State, the United States, any other State of the United States as defined infra and any foreign country or government lawfully owning or possessing property within this State. See New Jersey Statutes 1:1-2
30. The School Employees’ Health Benefits Commission shall ensure that every contract purchased or renewed by the commission on or after the effective date of P.L.2023, c.105 (C. 17:48-6xx et al.), shall provide benefits to a person covered thereunder for expenses incurred for a prescription asthma inhaler, if recommended or prescribed by a participating physician or participating nurse practitioner/clinical nurse specialist. Coverage for the purchase of a covered prescription asthma inhaler shall not be subject to any deductible, and no copayment or coinsurance for the purchase of a covered prescription asthma inhaler shall exceed $50 per 30-day supply, except a contract provided by the School Employees’ Health Benefits Commission that qualifies as a high-deductible health plan shall provide coverage for the purchase of a covered prescription asthma inhaler at the lowest deductible and other cost-sharing requirement permitted for a high-deductible health plan under section 223(c)(2)(A) of the Internal Revenue Code (26 U.S.C. § 223 (c)(2)(A)). The provisions of this section shall apply to a plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. 156.155, to the maximum extent permitted by federal law.
Nothing in this section shall prevent the School Employees’ Health Benefits Commission from reducing a covered person’s cost-sharing requirement by an amount greater than the amount specified in this section or prevent the commission from utilizing formulary management, including a mandatory generic policy, to promote the use of lower-cost alternative generic drugs that are the therapeutic equivalent of the brand-name drug, which could result in the member’s copay being higher than set forth in this section.
L.2023, c.105, s.30.