Requires Health Insurers to Limit Patient Cost-Sharing
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 Benson and Angelica Jimenez to require health insurers to cap patient co-payments was signed into law by the Governor on Tuesday.
“Now more than ever, the need for this law is critical,” said Assemblyman Daniel 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 law (A-2431), unless a 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 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 Assemblywoman Angelica Jimenez (D-Bergen, Hudson). “Some of these individuals, although they have insurance, cannot afford the exorbitant out-of-pocket expenses for their much-needed prescription medications. We can do more to help residents with prescription costs under this new law.”
Specifically, 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 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 law received unanimous legislative approval, 75-0 in the full Assembly and 40-0 in the Senate, on January 13, 2020.