STATE OF NEW JERSEY
PRE-FILED FOR INTRODUCTION IN THE 2020 SESSION
Assemblyman ROBERT J. KARABINCHAK
District 18 (Middlesex)
Assemblywoman PAMELA R. LAMPITT
District 6 (Burlington and Camden)
Assemblywoman JOANN DOWNEY
District 11 (Monmouth)
Assemblymen Freiman and Benson
Places $100 cap on amount paid by covered persons for purchase of insulin drugs; requires Division of Consumer Affairs to investigate insulin prices.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning prescription insulin coverage and supplementing P.L.1997, c.192.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A carrier that provides coverage for prescription drugs pursuant to the terms of a health benefits plan offered by the carrier shall not require a covered person to pay, for a covered prescription insulin drug, an amount exceeding $100 per 30 day supply of insulin, regardless of the amount or type of insulin needed to fill the covered person’s prescription.
b. Nothing in this section shall prevent a carrier from reducing a covered person’s cost sharing by an amount greater than the amount specified in this section.
c. As used in this section, “prescription insulin drug” means articles that contain insulin and are used to treat diabetes, including:
(1) articles recognized in the official United States Pharmacopoeia, official Homeopathic Pharmacopoeia of the United States, or official National Formulary, or any supplement to any of them;
(2) articles intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease in man or other animals;
(3) articles, other than food, intended to affect the structure or any function of the body of man or other animals; and
(4) articles intended for use as a component of any article specified in clause (1), (2), or (3).
“Prescription insulin drug” does not include biological products, or devices or their components, parts, or accessories.
2. a. The Division of Consumer Affairs in the Department of Law and Public Safety shall investigate the pricing of prescription insulin drugs made available to New Jersey consumers to ensure adequate consumer protections in the pricing of prescription insulin drugs and to determine whether additional consumer protections are needed.
b. As part of the investigation, the division shall gather, compile, and analyze information concerning the organization, business practices, pricing information, data, reports, or any other information that the division finds necessary to fulfill the requirements of this section, from companies engaged in the manufacture or sale of prescription insulin drugs. The division shall also consider any publicly available information related to drug pricing.
c. If necessary to fulfill the reporting requirements of this section, the Attorney General may request that a State department, carrier, pharmacy benefits manager, or manufacturer of prescription insulin drugs that are made available in this State, furnish material, answers, data, or other relevant information.
d. Within six months after enactment of P.L. , c. (C. ) (pending before the Legislature as this bill), the division shall issue and make available to the public a report detailing its findings. The division shall present the report to the Governor, the Commissioner of Banking and Insurance, and the Legislature pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1). The report shall include:
(1) A summary of insulin pricing practices and variables that contribute to the pricing of health benefits plans;
(2) Recommendations concerning how to:
(a) control and prevent the overpricing of prescription insulin drugs made available to New Jersey consumers; and
(b) prevent deceptive sales practices related to the sale of prescription insulin drugs, including the pricing of those drugs; and
(3) Any other information the division finds necessary.
3. This act shall take effect on the first day of the seventh month next following the date of enactment, but the Commissioner of Banking and Insurance may take such anticipatory administrative action in advance thereof as shall be necessary for the implementation of the act.
This bill provides that carriers that provide coverage for prescription drugs pursuant to the terms of a health benefits plan offered by the carrier are prohibited from requiring a covered person to pay, for a covered prescription insulin drug, an amount exceeding $100 per 30 day supply of insulin, regardless of the amount or type of insulin needed to fill the covered person’s prescription.
In addition, the bill requires the Division of Consumer Affairs in the Department of Law and Public Safety to investigate the pricing of prescription insulin drugs that are available to New Jersey consumers to determine whether additional consumer protections in the pricing of prescription insulin drugs are needed.
The division is required to issue and make available to the public a report detailing its findings and present the report to the Governor, the Commissioner of Banking and Insurance, and the Legislature.