TRENTON, NJ – The Assembly Budget Committee has given a favorable report with committee amendments to Senate Bill No. 1614 (1R). The bill aims to establish a flat cap on out-of-pocket contributions for individuals who require certain prescription medications, including insulin, epinephrine auto-injectors, and prescription asthma inhalers. The coverage standards outlined in the bill apply to various insurance providers and health benefits plans.
Under the amended bill, individuals prescribed short-acting, intermediate-acting, rapid-acting, long-acting, or pre-mixed insulin products, epinephrine auto-injector devices, or prescription asthma inhalers would have a limit on their out-of-pocket expenses. These items would not be subject to deductibles, and copayments or coinsurance would be capped at specific amounts. For a 30-day supply of insulin, the copayment or coinsurance would be limited to $35. Epinephrine auto-injector devices would have a copayment or coinsurance cap of $25 per 30-day supply, while prescription asthma inhalers would be limited to $50 per 30-day supply.
These coverage standards will apply to individual or group hospital service corporations, medical service corporations, and health service corporations, as well as individual and group health insurance policies and health maintenance organizations. The bill also extends these standards to individual and small employer health benefits plans. Additionally, the State Health Benefits Commission and the School Employee’s Health Benefits Commission will be required to ensure that their contracts comply with the coverage standards.
The committee’s report states that Senate Bill No. 1614 (1R) is identical to Assembly Bill No. 2839 (1R), which has also been amended and reported favorably by the committee.