LEGISLATIVE FISCAL ESTIMATE
[Second Reprint]
SENATE, No. 1614
STATE OF NEW JERSEY
220th LEGISLATURE
DATED: JULY 3, 2023
SUMMARY
Synopsis: Requires health insurance carriers to provide coverage for epinephrine
auto-injector devices and asthma inhalers; limits cost sharing for
health insurance coverage of insulin.
Type of Impact: Potentially no impact on the State General Fund; potential expenditure
increase on local government funds and school district funds.
Agencies Affected: Division of Pensions and Benefits, Department of the Treasury; local
governments; school districts
Office of Legislative Services Estimate
Fiscal Impact Year 1 Year 2 Year 3
State Cost Impact Indeterminate
Potential Local Cost Increase Indeterminate
 This Office of Legislative Services (OLS) concludes the bill will result in an indeterminate
annual increase in the cost of prescription drug plans provided to public employees by local
governments and school districts to the extent that current plans exceed the limits specified in
the bill. The OLS cannot estimate the cost because the coverage requirements in all the plans
provided to public employees is not known and the number of prescriptions for insulin
products, epinephrine auto-injector devices, or asthma inhalers also is unknown. In addition,
the extent to which the employers and employees will cover these increased costs through
premium sharing is not known.
 This bill will apply to local governments that participate in the State Health Benefits Program
(SHBP) and to school districts that participate in the School Employees’ Health Benefits
Program (SEHBP). It will also apply to those local government and school district employers
that purchase prescription drug plans outside of the programs.
 The bill likely will have no impact on the State General Fund given the current coverage in the
prescription drug plans in the SHBP for State employees.
Office of Legislative Services Legislative Budget and Finance Office
State House Annex Phone (609) 847-3105
P.O. Box 068 Fax (609) 777-2442
Trenton, New Jersey 08625 www.njleg.state.nj.us
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BILL DESCRIPTION
This bill places a flat cap on the out-of-pocket contribution for any covered person prescribed
an insulin product, an epinephrine auto-injector device, or an asthma inhaler across insurance
providers. Coverage for these items may not be subject to any deductible, and copayments or
coinsurance are capped at $35 per 30-day supply of insulin, $25 for epinephrine auto-injector
devices per 30-day supply, and $50 for prescription asthma inhalers per 30-day supply.
For the State Health Benefits Program and the School Employees' Health Benefits Program,
the bill does not prevent the programs from reducing an enrollee's cost-sharing requirement by an
amount greater than the amount specified in the bill or prevent the commission from utilizing
formulary management, including a mandatory generic policy, to promote the use of lower-cost
alternative generic drugs that are the therapeutic equivalent of the brand-name drug, which could
result in the member’s copay being higher than set forth in this bill.
This bill will apply to individual or group hospital service corporations, medical service
corporations, health service corporations, individual and group health insurance policies, health
maintenance organizations, the State Health Benefits Commission, and the School Employee’s
Health Benefits Commission.
FISCAL ANALYSIS
EXECUTIVE BRANCH
None received.
OFFICE OF LEGISLATIVE SERVICES
The OLS concludes this bill will result in an indeterminate increase in the cost of prescription
drug plans provided to public employees by local governments and school districts to the extent
that current plans exceed the limits specified in the bill. The OLS cannot estimate the cost because
the coverage requirement in all the plans provided to public employees is not known and the
number of prescriptions for insulin products, epinephrine auto-injector devices, or asthma inhalers
also is unknown. In addition, the extent to which the employers and employees will cover these
increased costs through premium sharing is not known.
This bill will apply to local governments that participate in the SHBP and to school districts
that participate in the SEHBP. It will also apply to those local government and school district
employers that purchase prescription drug plans outside of the programs.
The bill likely will have no impact on the State General Fund given the current coverage in the
prescription drug plans in the State Health Benefits Program for State employees.
It should be noted that, for the SHBP and the SEHBP, the bill does not prevent the programs
from reducing an enrollee's cost-sharing requirement by an amount greater than the amount
specified in the bill or prevent the commission from utilizing formulary management, including a
mandatory generic policy, to promote the use of lower-cost alternative generic drugs that are the
therapeutic equivalent of the brand-name drug, which could result in the member’s copay being
higher than set forth in this bill.
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3
Section: State Government
Analyst: Anna Harris
Assistant Fiscal Analyst
Approved: Thomas Koenig
Legislative Budget and Finance Officer
This legislative fiscal estimate has been produced by the Office of Legislative Services due to the
failure of the Executive Branch to respond to our request for a fiscal note.
This fiscal estimate has been prepared pursuant to P.L.1980, c.67 (C.52:13B-6 et seq.).


Statutes affected:
Introduced: 17:48-6, 17:48A-7, 17:48E-35.11, 17B:26-2.1, 17B:27-46.1, 26:2J-4.11
Advance Law: 17:48-6, 17:48A-7, 17:48E-35.11, 17B:26-2.1, 17B:27-46.1, 26:2J-4.11
Pamphlet Law: 17:48-6, 17:48A-7, 17:48E-35.11, 17B:26-2.1, 17B:27-46.1, 26:2J-4.11