Weinberg Bill to Limit Cost-Sharing for Prescription Drug Coverage Cleared the Budget Committee

Trenton – Legislation sponsored by Senate Majority Leader Loretta Weinberg, which would limit the amount a person pays out-of-pocket for prescription drugs each month, cleared the Senate Budget and Appropriations Committee today.

“The state of our current healthcare system is in untenable,” said Senator Weinberg (D-Bergen).  “Health insurance is worthless if the doctor prescribed medication is unaffordable. For patients with chronic conditions in particular, out-of-pocket costs can range into the thousands of dollars each month, putting both their health and their livelihood in jeopardy. Of all the problems we are facing with our convoluted system, forcing people to choose between the drug they need to feel healthy and the food they need to survive is particularly shameful.”

A cost-sharing charge is the amount an individual has to pay for a medical item or service covered by his health insurance plan.

The bill, S-1865, would require insurers limit costs to $150 per drug per month for silver, gold, and platinum plans and $250 per drug per month for bronze plans. At least 25 percent of all plans, or at least one plan if the insurer offers less than four plans, would be required to offer the benefit in the individual and small employer market and two plans in the large group market.

The bill would also limit co-pays in the State health benefit plans to $200 per drug per month.

The bill, also sponsored by Senator Thomas Kean Jr., would apply to the following insurers and programs that provide coverage for prescription drugs under a policy or contract:  health, hospital and medical service corporations; commercial individual and group health insurers; health maintenance organizations; health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs; the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP).

The bill would take effect immediately.

The bill was approved by committee by a vote of 13-0.