Benson & Jimenez Bill to Cap Prescription Drug Costs Clears Assembly

Would Require Health Insurers to Limit Patient Cost-Sharing

(TRENTON) – To reduce the out-of-pocket burden faced by many New Jerseyans covered by certain prescription drug insurance policies or contracts, legislation sponsored by Assembly Democrats Daniel R. Benson and Angelica Jimenez that would require health insurers to cap patient co-payments cleared the full Assembly Monday by a vote of 77-1-0.

“Now more than ever, the need for this bill is critical,” said Benson (D-Mercer, Middlesex). “Increasingly, health plans are imposing a serious financial burden on patients whose diseases and conditions are treated by so-called ‘specialty’ medications. That burden usually comes in the form of coinsurance, which can leave enrollees of health care plans left to pay thousands of dollars for one month’s supply of a specialty medication. It is absolutely unacceptable that nearly every health plan available on the Healthcare.gov marketplace features co-payments of between 40-50 percent for ‘specialty’ medications which are life-sustaining drugs for those who take them. We can and will do better for the people of New Jersey.”

Under the bill (A-2431), unless the plan or contract is required to provide bronze level of coverage or is a catastrophic plan under the federal Affordable Care Act, insurers must ensure that plans limit a covered person’s out-of-pocket financial responsibility.

“Many of the individuals who face high copayments, coinsurance or deductibles are already suffering with difficult and expensive health issues,” said Jimenez (D-Bergen, Hudson). “Some of these individuals, although they have insurance, cannot afford the exorbitant out-of-pocket expenses them for their much-needed prescription medications.”

Specifically, under the bill, for individuals with a silver, gold or platinum level of coverage, any copayment or coinsurance for prescription drugs, including specialty drugs, cannot exceed $150 per month for each prescription for up to a 30-day supply.

If a plan or contract is required to provide a bronze level of coverage, the plan shall ensure that any required enrollee cost-sharing, including any copayment or coinsurance, does not exceed $250 per month for each 30-day supply of a prescription.

The bill cleared the Assembly Appropriations Committee on March 18. A companion bill in the Senate (S-1865) has been referred to the Senate Commerce Committee.