NJ A1825

Requires step therapy protocols under Medicaid, State Health Benefits Program (SHBP), and School Employees' Health Benefits Program (SEHBP) to be based on clinical practice guidelines developed by multidisciplinary expert panels using objective data and high-quality research

Mandates a clear exception process allowing prescribing providers to override step therapy requirements when the required drug is contraindicated, likely to cause harm, expected to be ineffective, or when formulary drugs have already failed the patient

Requires decisions on step therapy exception requests within 24 hours for urgent cases and 72 hours for non-urgent cases, with coverage authorized for at least 180 days when exceptions are granted

Requires managed care organizations and vendors to publish step therapy exception approval and denial statistics on their websites in a readily accessible format

Takes effect January 1, 2026, applying to all contracts and policies delivered, issued, executed, or renewed on or after that date