(Effective July 1, 2026)
On September 24, 2025, the NJ SHBP Plan Design Committee (PDC) met and approved several changes to the prescription drug plans for the State Health Benefits Program – Local Government (SHBP-LG). The changes were initially planned for January 1, 2026, but were delayed.
On February 11, 2026, the PDC announced key updates to the previously approved SHBP-LG plan options, leading with the effective date which is now slated to be July 1, 2026.
Key Updates
For SHBP-LG Actives and Early Retirees, the plan design changes do not apply to the current plan options. Instead, a new plan option was created that will be offered alongside the other available plans. There were no changes to Medicare-eligible retirees.
Effective July 1, 2026 the new plan offering will have the following plan design:
- ● Non-diabetic GLP-1 drugs prescribed for weight loss will have a $45 copay per 30-day supply until the State implements a lifestyle management program. Once the program is active, members who participate will continue paying the $45 copay, while those who do not participate in a lifestyle management program will see their copay rise to $125 per 30-day supply. The implementation of this program is still uncertain at this time but intended to be available for July 1, 2026.
- ● Generic drugs: $10 retail (per 30-day supply) / $10 mail order (90-day supply)
- ● Preferred brand drugs: $20 retail (per 30-day supply) / $50 mail order (90-day supply)
- ● Non-preferred brand drugs: $75 retail (per 30-day supply) / $150 mail order (90-day supply)
- ● Specialty drugs: $75 (available through mail order only, up to a 30-day supply)
In addition, mail order will become mandatory for all maintenance drugs. The resolution also sets new out-of-pocket maximums for prescription drug benefits: $2,120 for individuals and $4,240 for families. All other prescription benefits remain unchanged—such as mandatory generic, mandatory mail order for specialty drugs, step therapy, and an exclusionary formulary.
The new plan option provides for a 4.7% rate reduction off of the January 2026 renewal increase for the Rx for local government actives that enroll in the plan. For the early retirees who enroll in this plan, the rate reduction is 2.9% off the January 2026 renewal increase. These rates do include a 6% margin to help build the CSR balance plus an additional load to collect amounts owed under Chapter 86.
Benecard will continue to closely monitor this ongoing situation and keep you updated on any further developments or communications related to the NJ SHBP-LG. In the meantime, if you have any questions on this topic, please email us at talktous@benecard.com.
Sources:
1 “SHBP PDC Resolution #2025-11”, NJ Treasury
2 “State Health Benefits Program – July 2026 Premium Rate Update”, AON
