Lawmakers vote to cap out-of-pocket prescription costs

Lawmakers vote to cap out-of-pocket prescription costs

TRENTON, N.J. – Legislation capping out-of-pocket expenses for prescription drugs earned Assembly approval today. Assemblywoman BettyLou DeCroce sponsors the bill (A2431) limiting a patient’s share to $150 or $250 a month depending on the health benefit plan level.

BettyLou DeCroce
“Many people with high-cost-sharing plans don’t take vital medications prescribed by their doctors because they can’t afford their co-pays,” said DeCroce (R-Morris). “The result is poor health outcomes and increased long term costs for chronically ill patients. Capping out-of-pocket payments will reduce health care costs in the long run.”

A study commissioned by the Leukemia and Lymphoma Society found a connection between high-deductible plans and lower medication utilization and adherence, leading to poor outcomes and an increase in the cost of care.

Similar measures have passed in Delaware, Maryland, Louisiana, California and the District of Columbia. Maine and Vermont have limits on the annual out-of-pocket costs to consumers, and Virginia and five other states require insurance companies to provide notice to consumers of cost-sharing tiers and all changes to the plans.

The provisions of DeCroce’s bill apply to the state’s individual and small employer plans, the state health benefits program and the school employees’ health benefits program.