New Law Placing Prescription Limits and Mandating Insurance Coverage for Substance Use Disorders


On February 15, 2017, Governor Christie signed into law a bill that limits prescriptions by physicians for opioid painkillers and requires insurance carriers to cover treatment for addiction and substance use disorders. Under the new law, the strictest on opioid prescription in the country, a five-day limit is imposed on initial prescriptions for opioids. The law contains certain exceptions, such as for cancer or hospice patients. Previously, the limit in New Jersey was a thirty-day supply.

The law also requires insurers to cover up to 180 days of drug treatment for patients, including both outpatient and inpatient treatment. In addition, insurers may not impose utilization review or management requirements on treatment or prior approval requirements for covered medication-assisted treatments. Insurers also must not impose prepayment obligations and may only charge a plan’s regular copayments, deductibles and co-insurance for substance use disorder treatment.

The law also requires the state to provide monitoring in order to prevent fraud or abuse and to ensure that providers are not improperly treating patients who do not actually require substance abuse treatment. The new drug treatment mandate does not apply to insurance programs that are not subject to state regulation, such as Medicare or large-employer plans.

Related Practices:   Healthcare Law