The (Never-Ending) Search for Healthcare Savings

Before the Legislature wrapped up for the summer, lawmakers took their shot at trying to address the growing cost of healthcare in New Jersey. The following bills – all on the governor’s desk as this column goes to print – could impact consumers, employers, pharmaceutical manufacturers, pharmacy benefit managers, wholesale drug distributors and insurance carriers.

Prescription Drug Affordability

S-1614/A-2839 Requires health insurance carriers to provide coverage for epinephrine auto-injector devices and asthma inhalers; limits cost-sharing for insurance coverage of insulin.

S-1615/A-2840 Requires certain data reporting for the prescription drug supply chain; establishes Drug Affordability Council; appropriates $1.5 million.

S-1616/A-536 Establishes new transparency standards for pharmacy benefits manager business practices.

Senate Bill S-1615’s new tax/assessment on insurance carriers and the provision requiring advance notification of price changes, will have substantial implications if signed into law. NJBIA was vocal about confidentiality concerns and placing prescription drug manufacturers at a competitive disadvantage to other entities in the supply chain. Only time will tell whether such provisions that stand to make New Jersey a competitive outlier will have the intended effect of addressing healthcare costs.

Small Employer Healthcare Affordability

S-3480/A-5137 “The Small Business Health Insurance Affordability Act” revises certain requirements for individual and small employer health benefits plans.

S-2824/A-4294 Requires Department of Banking and Insurance (DOBI) to conduct a study on the impact of certain changes to individual and small group health insurance markets.

Senate Bill S-3480 would permit insurance carriers to offer small employer health insurance plans without the requirement to also offer individual health plans, align cost-sharing requirements with the Affordable Care Act, and require an annual plan design review by the Small Employer Health Benefits Board with results posted to DOBI’s website. Senate Bill S-2824 would require DOBI to research and investigate market reforms that could make small-market coverage more affordable, such as merging the individual and small employer markets and creating small employer subsidies, among others.

Supported by NJBIA, both bills bring much-needed attention to the small group market, a market that once covered nearly 1 million lives in 2005, but has steadily declined since due to federal definition changes, Medicaid expansion and the availability of individual market subsidies.

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