Prescription Caps For Some Products To Begin Soon In NJ

NEW JERSEY — Come January, New Jersey will begin enforcing new limits on out-of-pocket costs for insulin, asthma inhalers, and diabetes medication.

State officials recently issued guidance to health benefit carriers on these new price caps, and to a recent update in coverage for hearing aids and cochlear implants.

A package of laws signed last year sets monthly caps on coinsurance and copay costs for treatments for diabetes, epinephrine auto-injector devices (EpiPens), and prescription asthma inhalers. The new caps go into effect on Jan. 1, 2025.

For a 30-day supply, the legislation caps insulin products at $35, EpiPens at $25, and asthma inhalers at $50. Coverage of these drugs is also excluded from health plan deductibles.

The legislation made New Jersey the second state in the nation to cap out-of-pocket costs for asthma inhalers and EpiPens, in addition to capping consumer costs for insulin.

Since April, carriers have also been required to provide benefits for the purchase of a hearing aid or cochlear implant for any covered person 21 years old or younger. In the past, coverage was limited to New Jersey children under the age of 16, but older teenagers and adults are now included.

According to a 2023 study, more than half of New Jersey residents said they are “somewhat worried” or “very worried” about the price of prescription drugs. About one in four people said they were recently forced to skip a prescription, cut pills in half, or skip a dose because they couldn’t afford it.

New reporting requirements for drug companies and insurance carriers also went into effect in October, allowing the state to monitor what drives increases in prescription costs.