NJ lawmakers consider $50 a month cap on insulin prescriptions

Health benefits plans regulated by New Jersey would have to cap out-of-pocket costs for insulin prescriptions at $50 a month, under legislation that has taken first steps through the Senate and Assembly.

The bill would apply to co-payments or co-insurance charged by health benefits plans under the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs, the State Health Benefits Program, and the School Employees’ Health Benefits Program.

Assemblyman John McKeon, D-Essex, said insulin can be mass-produced very economically but that drug companies make tweaks to protect patents and stall generics.

“Over the last — I think it’s 15 years, give or take — the cost of insulin has tripled. Literally tripled,” McKeon said.

Assemblyman Rob Karibinchak, D-Middlesex, one of the bill’s lead sponsors, said insulin can be made more affordable to patients without impacting drug companies’ bottom line.

“This particular bill goes past the bottom line. This is about people’s lives. So there’s no issue in my mind about money,” Karibinchak said.

Aubrey Navarro-Conway, a Type 1 diabetic from Sayreville, said she took a second job because she struggles to afford her insulin.

“Pass this bill so that I can get back to my family and get some rest. So I can enjoy my children and my life again free from the constant feeling of impending doom,” Navarro-Conway said. "Being just one tiny misstep, one extra late fee or bill, one extra co-pay away from being unable to afford next month's insulin."

No lawmakers have voted against the bill, though two voted to abstain in the Assembly Financial Institutions and Insurance Committee.

Assemblyman Jay Webber, R-Morris, said the bill doesn’t change the price of insulin, just what some people pay out of pocket for it. Insurance companies will make that up through higher premiums, he said.

“You’re going to raise the prices on everybody in the state, including those people who could barely afford to pay for health insurance now and who don’t have diabetes,” Webber said.

Ward Sanders, president of the New Jersey Association of Health Plans, said the bill is “an insurance solution to a pricing problem.”

“You’re not magically lowering the cost of insulin. It’s the same price. It’s just that somebody else is paying for it. This is a cost-shifting bill rather than a cost-savings bill,” Sanders said.

The bill, A954/653/1669 and S526, requires insulin manufacturers to submit an annual report to the state Department of Banking and Insurance containing data about the manufacture, pricing, and sales of insulin products.

Matt Greller, a lobbyist for the Pharmacy Care Management Association said the discussion would be better focused on the prices set by drug companies. He said if cost sharing is set at $50, increases to it should also be tied to inflation.

“Five years from now, two years from now, 10 years out, will this number that’s being pegged in statue potentially still be the best number?” Greller said.

The proposal has been endorsed by the Senate Commerce Committee and Assembly insurance committee. It was "second referenced" in both houses to the appropriations committees for additional consideration before it can reach the full Senate and Assembly.

Michael Symons is State House bureau chief for New Jersey 101.5. Contact him at michael.symons@townsquaremedia.com.