STATE OF NEW JERSEY
220th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2022 SESSION
Sponsored by:
Assemblyman ROBERT J. KARABINCHAK
District 18 (Middlesex)
Assemblywoman ANNETTE QUIJANO
District 20 (Union)
Assemblyman CLINTON CALABRESE
District 36 (Bergen and Passaic)
Co-Sponsored by:
Assemblywoman Lampitt, Assemblyman Freiman, Assemblywoman Timberlake, Assemblyman Benson, Assemblywoman Reynolds-Jackson, Assemblymen DeAngelo, Stanley, Assemblywoman Jasey and Assemblyman Giblin
SYNOPSIS
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.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning cost sharing for insulin, amending P.L.1995, c.331, and supplementing various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. (New section) The Legislature finds and declares that:
a. The rising cost of insulin has created an affordability crisis that threatens the health and financial well-being of many diabetes patients.
b. Research by the non-partisan Health Care Cost Institute found that prices for insulin nearly doubled over the five year period from 2012 to 2016 and other studies show that prices for insulin have increased by 700% over the past two decades.
c. The lack of competition, transparency, and accountability in the prescription drug market has allowed manufacturers of insulin to exert extraordinary pricing power.
d. While insulin products have been on the market for almost a century, there is limited competition from lower-cost generics, in part due to aggressive efforts by brand name drug manufacturers to block the entry of generic insulin products into the market.
e. Even consumers with health insurance may face a lack of access to insulin due to the plan design of some health insurance policies.
f. For consumers without insurance, or with insurance coverage not subject to New Jersey State law, access to current and reliable cost information may be helpful to consumers and researchers trying to better understand the true cost of insulin.
g. It is, therefore, in the public interest to protect consumers by mandating insurance coverage cost sharing maximums in New Jersey to improve consumer access to insulin, and to provide for transparency and publication of drug company pricing of insulin.
2. Section 1 of P.L.1995, c.331 (C.17:48-6n) is amended to read as follows:
1. a. Every individual or group hospital service corporation contract providing hospital or medical expense benefits that is delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act shall provide benefits to any subscriber or other person covered thereunder for expenses incurred for the following equipment and supplies for the treatment of diabetes, if recommended or prescribed by a physician or nurse practitioner/clinical nurse specialist: blood glucose monitors and blood glucose monitors for the legally blind; test strips for glucose monitors and visual reading and urine testing strips; insulin; injection aids; cartridges for the legally blind; syringes; insulin pumps and appurtenances thereto; insulin infusion devices; and oral agents for controlling blood sugar. Coverage for the purchase of insulin shall not be subject to any deductible, and no copayment or coinsurance for the purchase of insulin shall exceed $50 per 30 day supply.
b. Each individual or group hospital service corporation contract shall also provide benefits for expenses incurred for diabetes self-management education to ensure that a person with diabetes is educated as to the proper self-management and treatment of their diabetic condition, including information on proper diet. Benefits provided for self-management education and education relating to diet shall be limited to visits medically necessary upon the diagnosis of diabetes; upon diagnosis by a physician or nurse practitioner/clinical nurse specialist of a significant change in the subscriber's or other covered person's symptoms or conditions which necessitate changes in that person's self-management; and upon determination of a physician or nurse practitioner/clinical nurse specialist that reeducation or refresher education is necessary. Diabetes self-management education shall be provided by a dietitian registered by a nationally recognized professional association of dietitians or a health care professional recognized as a Certified Diabetes Educator by the American Association of Diabetes Educators or a registered pharmacist in the State qualified with regard to management education for diabetes by any institution recognized by the board of pharmacy of the State of New Jersey.
c. The benefits required by this section shall be provided to the same extent as for any other sickness under the contract.
d. This section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
e. The provisions of this section shall not apply to a health benefits plan subject to the provisions of P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.).
f. The Commissioner of Banking and Insurance may, in consultation with the Commissioner of Health, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), promulgate and periodically update a list of additional diabetes equipment and related supplies that are medically necessary for the treatment of diabetes and for which benefits shall be provided according to the provisions of this section.
(cf: P.L.1995, c.331, s.1)
3. Section 2 of P.L.1995, c.331 (C.17:48A-7l) is amended to read as follows:
2. a. Every individual or group medical service corporation contract providing hospital or medical expense benefits that is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act shall provide benefits to any subscriber or other person covered thereunder for expenses incurred for the following equipment and supplies for the treatment of diabetes, if recommended or prescribed by a physician or nurse practitioner/clinical nurse specialist: blood glucose monitors and blood glucose monitors for the legally blind; test strips for glucose monitors and visual reading and urine testing strips; insulin; injection aids; cartridges for the legally blind; syringes; insulin pumps and appurtenances thereto; insulin infusion devices; and oral agents for controlling blood sugar. Coverage