TRENTON, NJ -- A measure sponsored by Mercer County Assemblyman Dan Benson (D-Hamilton) to limit the out-of-pocket costs for prescription drugs was signed into law on Tuesday by Governor Phil Murphy. The new law requires health insurers to provide prescription drug coverage plans that limit patient cost-sharing; will improve affordability; and provide access for those who require necessary medication.
"Few issues have a greater financial impact on New Jersey families than the unpredictable and ever-increasing cost of prescription drugs," said Murphy. "Cost-sharing too often presents a barrier to a patient's ability to access medically-necessary treatments. This legislation will improve the affordability of medical care for many residents who unfortunately must make sacrifices in order to pay for their required medications."
Now, insurers must ensure that plans limit a covered person’s out-of-pocket financial responsibility unless a plan or contract is required to provide bronze level of coverage or is a catastrophic plan under the federal Affordable Care Act,
"Now, more than ever, the need for this law is critical," said Benson. "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," added Benson.
The law specifically sets guidelines for individuals with a silver, gold or platinum level of coverage, any copayment or coinsurance for prescription drugs, including specialty drugs. Copayments or coinsurance now 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.
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