New Jersey Assembly Bill A553

New Jersey 2022-2023 Regular Session

• Introduced: 1/11/22
• Refer: 1/11/22

Caption

Provides that purchase of insulin is not subject to deductible; requires health insurers to limit copayments and coinsurance for insulin; requires insulin manufacturers to submit report to Commissioner of Banking and Insurance.

Impact

The bill's implementation could significantly improve access to insulin for many patients in New Jersey, reducing the financial burden on individuals that face steep costs with existing health plans. By removing deductibles on insulin and capping out-of-pocket costs, it is designed to enhance adherence to treatment for diabetes, ultimately aiming to improve public health outcomes. The bill is based on findings that insulin prices have escalated dramatically over recent years, creating an urgent need for regulatory intervention in health insurance coverage policies.

Summary

Assembly Bill A553 addresses the rising costs of insulin and the associated affordability crisis threatening diabetes patients' health and financial stability in New Jersey. It mandates that health benefits plans, including those for the State Health Benefits Program and Small Employer Health Benefits Programs, must cover insulin without subjecting it to a deductible. Furthermore, the bill limits copayments or coinsurance for insulin prescriptions to a maximum of $50 for a 30-day supply. This legislative move is seen as a crucial step to ensure better accessibility to insulin for patients reliant on it for managing their diabetes.

Contention

Despite its positive intentions, Assembly Bill A553 may face contention regarding the influence of pharmaceutical companies and the potential for pushback regarding the profitability margins for insulin manufacturers. With the bill requiring annual reporting from insulin producers on their pricing and sales, companies may resist providing transparency, fearing it could expose their pricing strategies. Additionally, while the bill aims to standardize coverage across health plans, there could be concerns about the adequacy of competition within the insulin market, particularly regarding generic alternatives.