NJ Residents May Soon Get Easier Access To Pain Meds

An Assembly committee has approved a bill sponsored by Assembly members Herb Conaway, Jr., M.D. and Dan Benson 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 legislation addresses “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.

Conaway explains, “The purpose of step therapy is to control costs and minimize risks, but for some patients, this method does not work. 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.”

The measure 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. It 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.

“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,” says Benson. “Treatment decisions should be made by physicians, not insurance companies.”