NJ Passes Legislation to Mirror Some Medicare Regulations

July 21, 2023

Extending some of the recent prescription caps and data transparency requirements under the new Medicare payment rules, NJ has followed suit to place caps on some very important and needed medications, including insulin and EpiPens.  If you recall, the price of EpiPens jumped after some shifts in the market and pharma firm sales and consolidation.

While there is still a lot of work to be done, one of the most important pieces of this very complex area of healthcare payment, is the passing on of rebates to state employee benefit programs.  I was lucky enough at a point in my life to have been covered by the State of NJ benefit package, it is very costly.  Part of the process is the payment of rebates that the Pharmacy Benefit Manager (PBM) receives from the pharma company, will now need to be returned to the State to offset the cost of providing insurance coverage.  This, by the way, is an ongoing issue in the Medicaid space, where the PBMs are supposed to make the rebate payments to the state program.

There will hopefully be a lot of other states doing what New jersey has done with respect on price caps (at a minimum).  Insulin, asthma inhalers and EpiPens are life saving medications, and for people to have to make a decision about feeding themselves and their family and getting a life saving medication is something that legislation like this can help resolve.

By Eric Rubenstein

You May Also Like…

Drugs: Deal or No Deal

Drugs: Deal or No Deal

The only government program that I can think of that did not authorize price negotiations for prescription medications...

Moral Injuries

Moral Injuries

If you are an avid reader of our newsletter or blogs, you know that we focus on payment integrity, program integrity,...