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Orally Administered Cancer Medication Coverage Law

Orally Administered Cancer Medication Coverage Law Effective as of July 15, 2012
New Jersey Public Law, 2011, C. 188, requires health insurance carriers to cover cancer medications taken orally “on a basis no less favorable than” intravenous or injected cancer medications.

Coverage for prescribed orally administered cancer medications is not to be subject to any prior authorizations, dollar limitations, deductibles, copayments or coinsurance that does not apply to intravenously administered or injected cancer medications.

Orally administered cancer drugs are prescription drugs that: (a) are used to slow or kill the growth of cancerous cells, and (b) are given orally (by mouth).

Such drugs do not include those that:

  • Maintain red or white cell counts.
  • Treat nausea.
  • Support the cancer prescription drugs.

Affected insurance plans
This law, effective as of July 15, 2012, applies to those insured plans that are issued or renewed in the state of New Jersey on or after that date. The law also applies to the State Health Benefits Program (SHBP) and effective for their members as of July 15, 2012.

Downloadable information

  • Dedicated Claims Form: To help expedite your patients’ claims for oral medication(s), Horizon BCBSNJ created a dedicated claims form. Your patients will need to send in their patient prescription information leaflet and cash register receipt each time for their claims to be considered for reimbursement.
  • A comprehensive list of Orally Administered Cancer Medications affected by this new law is available.