Prior Authorization in New Jersey
New Jersey enacted S-1339 (2018) one of the first comprehensive step therapy reform laws. The law provides broad override criteria including when a prescriber determines the step is not in the patient's best interest. NJ requires PA decisions within 4 business days for standard and 24 hours for urgent requests.
Key Facts About PA in New Jersey
- ✓ One of the earliest comprehensive step therapy reform laws in the US
- ✓ Standard PA decisions within 4 business days; urgent within 24 hours
- ✓ Broad override criteria including "not in patient's best interest"
- ✓ NJ Department of Banking and Insurance oversees external review
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in New Jersey
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these New Jersey carriers:
Horizon BCBS New JerseyAetnaUnitedHealthcareCigna