New Jersey has finalized rules requiring state-regulated insurers to cap out-of-pocket costs on insulin, asthma inhalers and epinephrine auto-injectors.
The state published the final regulations Dec. 1, implementing legislation Gov. Phil Murphy signed that made New Jersey the second state to cap consumer costs for asthma inhalers and EpiPens in addition to insulin.
Under the rules, insurers in the fully insured market must cap out-of-pocket costs for insulin at $35 per 30-day supply, extending Medicare’s insulin cap to state-regulated markets and public employee plans. Asthma inhalers are capped at $50 per 30-day supply regardless of inhaler type, and EpiPens are capped at $25 per 30-day supply.
The caps apply to the individual and small employer markets, and insurers must provide the medications without any deductible. The regulations also require insurers to cover hearing aids and cochlear implants under a separate law, removing previous age limits and the $1,000 coverage cap.
