NJ Lawmakers Aim To Cap Costs Of Lifesaving Medications

NEW JERSEY — Some New Jersey residents who take insulin, carry EpiPens or asthma inhalers would see their costs drop dramatically under a package of bills state legislators have introduced to address prescription drug costs.

The bills, introduced in the state Senate Feb. 14 by Sens. Troy Singleton, Joseph F. Vitali and Nellie Pou, aim to address the issues facing low-income New Jersey residents with the cost of prescriptions in general.

The costs of insulin, EpiPens and asthma inhalers — lifesaving medications for those who need them — have escalated in the last 10 years.

The rising costs have led to millions of Americans skipping their medication, especially among those 65 or older, according to a Gallup poll in September 2021. Others ration doses to stretch their supply.

Insulin in particular has been in the spotlight, with retail prices ranging from as low as $25 to $350 per 10-milliliter vial with 100 doses (the pen insulin dispensers cost nearly double for a similar amount of insulin), according to GoodRx Health, a prescription medication price comparison website.

Some diabetics go through six vials of insulin per month, according to SingleCare, another company that offers discounted prices. The blog post notes that many drug companies offer programs to help those in need with the costs of insulin.

Those programs often don’t reach those in dire need, however.

Also controversial has been the cost of epinephrine auto-injectors, usually referred to as EpiPens based on the name of the most common brand. The injectors retail for as much as $700 per box of two pens and have to be replaced yearly — sooner if they are used. The price of the auto-injectors has risen from $50 in 2007 when the rights to EpiPen were purchased by Mylan, according to ARS Technica.

The injectors are used to treat someone suffering from severe allergic reactions to prevent them from going into anaphalaxis, a life-threatening allergic reaction where someone is unable to breathe.

Bill S1614 would cap out-of-pocket costs for insulin, EpiPens and asthma inhalers for those covered by state-regulated health plans, the state State Health Benefits plan or the School Employee Health Benefits plan. Insulin costs would be capped at $35 for a 30-day supply, EpiPens at $25, and asthma inhalers capped at $50.

About 2 million New Jersey residents would be affected by the legislation, state officials said.

Also part of the package is Bill S1615, which would require reports annually from pharmaceutical manufacturers, pharmacy benefit managers, wholesale drug distributors, and insurance carriers that would highlight “state specific spending, emerging trends in prescription drug pricing, and more,” state officials said.

A third bill, S1616, aims to improve oversight of drug pricing by pharmacy benefit managers by “setting standards for multiple-source generic pricing, preventing spread pricing,” and requiring transparency in contracts that benefit managers negotiate with insurance carriers and pharmacies.

Pharmacy benefit managers “play a critical role in negotiating rebates and discounts with downstream effects on drug pricing,” state officials said, adding they believe additional transparency will bring lower costs to patients.

Also in the works is a bill to allow the state Department of Human Services to join a multi-state Medicaid purchasing prescription drug pool to negotiate more competitive drug prices for the NJ FamilyCare program.

“Countless New Jerseyans struggle to afford the expense of prescription medicine, especially senior citizens, low-income families and individuals, and those who live with chronic health conditions,” said Vitale, chair of the Senate Health Committee. “We continue to make great strides in developing medications that can save lives and treat illnesses, but they are of no use if they are unaffordable.

“They shouldn’t be forced to choose between expensive medicines and paying for other basic needs, and they shouldn’t be put in the position of skipping doses to stretch their prescription,” Vitale said.

“When at least 10 percent of American adults are forced to ration their medicine because they cannot pay for regular doses, the need for systemic change is indisputable,” said Assemblyman John McKeon, who has introduced Assembly versions of the bills. “We must take a strategic approach to getting to the bottom of our state’s prescription drug affordability crisis in order to reduce the strain on our health care system and, more importantly, ensure every resident who needs medication can have access to it.”

The bills that were just introduced Feb. 14 have been assigned to committees but it’s unclear how soon they will be advanced to the full Senate and Assembly for action.

Gov. Phil Murphy called the bills “a major step forward for both short and long-term affordability.”

“As I highlighted in my State of the State address just a few weeks ago, I am deeply committed to making high-quality health care more affordable for all New Jerseyans,” Murphy said. “From the lifesaving medications to the pills millions of consumers take every day to maintain their health, lowering the cost of prescription drugs is a critical component of our broader health care affordability efforts.

"We have made strong strides over the past four years to put health care back within reach of many, but we must continue to find new ways to save consumers money on health care," Murphy said.