Bill Text: NJ S291 | 2026-2027 | Regular Session | Introduced
Bill Title: Reduces copayments and coinsurance for asthma inhalers covered by certain health benefits plans.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced) 2026-01-13 - Introduced in the Senate, Referred to Senate Commerce Committee [S291 Detail]
Download: New_Jersey-2026-S291-Introduced.html
STATE OF NEW JERSEY
222nd LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION
Sponsored by:
Senator SHIRLEY K. TURNER
District 15 (Hunterdon and Mercer)
SYNOPSIS
Reduces copayments and coinsurance for asthma inhalers covered by certain health benefits plans.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning copayments and coinsurance for asthma inhalers and amending P.L.2023, c.105.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 3 of P.L.2023, c.105 (C.17:48-6yy) is amended to read as follows:
3. An individual or group hospital service corporation contract providing hospital or medical expense benefits that is delivered, issued, executed, or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of P.L.2023, c.105 (C.17:48-6xx et al.) shall provide benefits to a subscriber or other person covered thereunder for expenses incurred for a prescription asthma inhaler, if recommended or prescribed by a participating physician or participating nurse practitioner/clinical nurse specialist. Coverage for the purchase of a covered prescription asthma inhaler shall not be subject to any deductible, and no copayment or coinsurance for the purchase of a covered prescription asthma inhaler shall exceed [$50] $35 per 30-day supply. The provisions of this section shall apply to a high-deductible health plan to the maximum extent permitted by federal law, except if the plan is used to establish a medical savings account pursuant to section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a health savings account pursuant to section 223 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.223). The provisions of this section shall apply to the plan to the maximum extent that is permitted by federal law and does not disqualify the account for the deduction allowed under section 220 or 223, as applicable. The provisions of this section shall apply to a plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
Nothing in this section shall prevent a hospital service corporation from reducing a subscriber's or other covered person's cost-sharing requirement by an amount greater than the amount specified in this section.
(cf: P.L.2023, c.105, s.3)
2. Section 6 of P.L.2023, c.105 (C.17:48A-7vv) is amended to read as follows:
6. An individual or group medical service corporation contract providing hospital or medical expense benefits that is delivered, issued, executed, or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of P.L.2023, c.105 (C.17:48-6xx et al.) shall provide benefits to a subscriber or other person covered thereunder for expenses incurred for a prescription asthma inhaler, if recommended or prescribed by a participating physician or participating nurse practitioner/clinical nurse specialist. Coverage for the purchase of a covered prescription asthma inhaler shall not be subject to any deductible, and no copayment or coinsurance for the purchase of a covered prescription asthma inhaler shall exceed [$50] $35 per 30-day supply. The provisions of this section shall apply to a high-deductible health plan to the maximum extent permitted by federal law, except if the plan is used to establish a medical savings account pursuant to section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a health savings account pursuant to section 223 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.223). The provisions of this section shall apply to the plan to the maximum extent that is permitted by federal law and does not disqualify the account for the deduction allowed under section 220 or 223, as applicable. The provisions of this section shall apply to a plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
Nothing in this section shall prevent a medical service corporation from reducing a subscriber's or other covered person's cost-sharing requirement by an amount greater than the amount specified in this section.
(cf: P.L.2023, c.105, s.6)
3. Section 9 of P.L.2023, c.105 (C.17:48E-35.49) is amended to read as follows:
9. An individual or group health service corporation contract providing hospital or medical expense benefits that is delivered, issued, executed, or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of P.L.2023, c.105 (C.17:48-6xx et al.) shall provide benefits to a subscriber or other person covered thereunder for expenses incurred for a prescription asthma inhaler, if recommended or prescribed by a participating physician or participating nurse practitioner/clinical nurse specialist. Coverage for the purchase of a covered prescription asthma inhaler shall not be subject to any deductible, and no copayment or coinsurance for the purchase of a covered prescription asthma inhaler shall exceed [$50] $35 per 30-day supply. The provisions of this section shall apply to a high-deductible health plan to the maximum extent permitted by federal law, except if the plan is used to establish a medical savings account pursuant to section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a health savings account pursuant to section 223 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.223). The provisions of this section shall apply to the plan to the maximum extent that is permitted by federal law and does not disqualify the account for the deduction allowed under section 220 or 223, as applicable. The provisions of this section shall apply to a plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
Nothing in this section shall prevent a health service corporation contract from reducing a subscriber's or other covered person's cost-sharing requirement by an amount greater than the amount specified in this section.
(cf: P.L.2023, c.105, s.9)
4. Section 12 of P.L.2023, c.105 (C.17B:26-2.1rr) is amended to read as follows:
12. An individual health insurance policy providing hospital or medical expense benefits that is delivered, issued, executed, or renewed in this State pursuant to Chapter 26 of Title 17B of the New Jersey Statutes or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of P.L.2023, c.105 (C.17:48-6xx et al.) shall provide benefits to a person covered thereunder for expenses incurred for a prescription asthma inhaler, if recommended or prescribed by a participating physician or participating nurse practitioner/clinical nurse specialist. Coverage for the purchase of a covered prescription asthma inhaler shall not be subject to any deductible, and no copayment or coinsurance for the purchase of a covered prescription asthma inhaler shall exceed [$50] $35 per 30-day supply. The provisions of this section shall apply to a high-deductible health plan to the maximum extent permitted by federal law, except if the plan is used to establish a medical savings account pursuant to section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a health savings account pursuant to section 223 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.223). The provisions of this section shall apply to the plan to the maximum extent that is permitted by federal law and does not disqualify the account for the deduction allowed under section 220 or 223, as applicable. The provisions of this section shall apply to a plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
Nothing in this section shall prevent an individual health insurer from reducing a covered person's cost-sharing requirement by an amount greater than the amount specified in this section.
(cf: P.L.2023, c.105, s.12)
5. Section 15 of P.L.2023, c.105 (C.17B:27-46.1xx) is amended to read as follows:
15. A group health insurance policy providing hospital or medical expense benefits that is delivered, issued, executed, or renewed in this State pursuant to Chapter 27 of Title 17B of the New Jersey Statutes or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of P.L.2023, c.105 (C.17:48-6xx et al.) shall provide benefits to a person covered thereunder for expenses incurred for a prescription asthma inhaler, if recommended or prescribed by a participating physician or participating nurse practitioner/clinical nurse specialist. Coverage for the purchase of a covered prescription asthma inhaler shall not be subject to any deductible, and no copayment or coinsurance for the purchase of a covered prescription asthma inhaler shall exceed [$50] $35 per 30-day supply. The provisions of this section shall apply to a high-deductible health plan to the maximum extent permitted by federal law, except if the plan is used to establish a medical savings account pursuant to section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a health savings account pursuant to section 223 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.223). The provisions of this section shall apply to the plan to the maximum extent that is permitted by federal law and does not disqualify the account for the deduction allowed under section 220 or 223, as applicable. The provisions of this section shall apply to a plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
Nothing in this section shall prevent a group health insurer from reducing a covered person's cost-sharing requirement by an amount greater than the amount specified in this section.
(cf: P.L.2023, c.105, s.15)
6. Section 18 of P.L.2023, c.105 (C.26:2J-4.50) is amended to read as follows:
18. A contract for health
care services that is delivered, issued, executed, or renewed in this State
pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) or approved for issuance or
renewal in this State on or after the effective date of P.L.2023, c.105 (C.17:48-6xx
et al.) shall provide benefits to an enrollee or other person covered
thereunder for expenses incurred for a prescription asthma inhaler, if
recommended or prescribed by a participating physician or participating nurse
practitioner/clinical nurse specialist. Coverage for the purchase of a covered
prescription asthma inhaler shall not be subject to any deductible, and no
copayment or coinsurance for the purchase of a covered prescription asthma
inhaler shall exceed
[$50] $35 per
30-day supply. The provisions of this section shall apply to a high-deductible
health plan to the maximum extent permitted by federal law, except if the plan
is used to establish a medical savings account pursuant to section 220 of the
federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a health savings
account pursuant to section 223 of the federal Internal Revenue Code of 1986
(26 U.S.C. s.223). The provisions of this section shall apply to the plan to
the maximum extent that is permitted by federal law and does not disqualify the
account for the deduction allowed under section 220 or 223, as applicable. The
provisions of this section shall apply to a plan that meets the requirements of
a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the maximum extent
permitted by federal law.
Nothing in this section shall prevent a health maintenance organization from reducing an enrollee's or other covered person's cost-sharing requirement by an amount greater than the amount specified in this section.
(cf: P.L.2023, c.105, s.18)
7. Section 21 of P.L.2023, c.105 (C.17B:27A-7.33) is amended to read as follows:
21. An individual health
benefits plan that provides hospital and medical expense benefits and is
delivered, issued, executed, or renewed in this State pursuant to P.L.1992,
c.161 (C.17B:27A-2 et al.), on or after the effective date of P.L.2023, c.105 (C.17:48-6xx
et al.), shall provide benefits to an enrollee or other person covered
thereunder for expenses incurred for a prescription asthma inhaler, if
recommended or prescribed by a participating physician or participating nurse
practitioner/clinical nurse specialist. Coverage for the purchase of a covered
prescription asthma inhaler shall not be subject to any deductible, and no
copayment or coinsurance for the purchase of a covered prescription asthma
inhaler shall exceed
[$50] $35
per 30-day supply. The provisions of this section shall apply to a
high-deductible health plan to the maximum extent permitted by federal law,
except if the plan is used to establish a medical savings account pursuant to
section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a
health savings account pursuant to section 223 of the federal Internal Revenue
Code of 1986 (26 U.S.C. s.223). The provisions of this section shall apply to
the plan to the maximum extent that is permitted by federal law and does not
disqualify the account for the deduction allowed under section 220 or 223, as
applicable. The provisions of this section shall apply to a plan that meets
the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to
the maximum extent permitted by federal law.
Nothing in this section shall prevent a carrier from reducing an enrollee's or other covered person's cost-sharing requirement by an amount greater than the amount specified in this section.
(cf: P.L.2023, c.105, s.21)
8. Section 24 of P.L.2023, c.105 (C.17B:27A-19.37) is amended to read as follows:
24. A small employer health
benefits plan that provides hospital and medical expense benefits and is
delivered, issued, executed, or renewed in this State pursuant to P.L.1992,
c.162 (C.17B:27A-17 et seq.), on or after the effective date of P.L.2023, c.105
(C.17:48-6xx et al.), shall provide benefits to an enrollee or other person
covered thereunder for expenses incurred for a prescription asthma inhaler, if
recommended or prescribed by a participating physician or participating nurse
practitioner/clinical nurse specialist. Coverage for the purchase of a covered
prescription asthma inhaler shall not be subject to any deductible, and no
copayment or coinsurance for the purchase of a covered prescription asthma
inhaler shall exceed
[$50] $35
per 30-day supply. The provisions of this section shall apply to a
high-deductible health plan to the maximum extent permitted by federal law,
except if the plan is used to establish a medical savings account pursuant to
section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a
health savings account pursuant to section 223 of the federal Internal Revenue
Code of 1986 (26 U.S.C. s.223). The provisions of this section shall apply to
the plan to the maximum extent that is permitted by federal law and does not
disqualify the account for the deduction allowed under section 220 or 223, as
applicable. The provisions of this section shall apply to a plan that meets
the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to
the maximum extent permitted by federal law.
Nothing in this section shall prevent a carrier from reducing an enrollee's or other covered person's cost-sharing requirement by an amount greater than the amount specified in this section.
The benefits shall be provided to the same extent as for any other condition under the health benefits plan.
This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
(cf: P.L.2023, c.105, s.24)
9. Section 27 of P.L.2023, c.105 (C.52:14-17.29mm) is amended to read as follows:
27. The State Health Benefits Commission shall ensure that every contract purchased or renewed by the commission on or after the effective date of P.L.2023, c.105 (C.17:48-6xx et al.), shall provide benefits to a person covered thereunder for expenses incurred for a prescription asthma inhaler, if recommended or prescribed by a participating physician or participating nurse practitioner/clinical nurse specialist. Coverage for the purchase of a covered prescription asthma inhaler shall not be subject to any deductible, and no copayment or coinsurance for the purchase of a covered prescription asthma inhaler shall exceed [$50] $35 per 30-day supply, except a contract provided by the State Health Benefits Commission that qualifies as a high-deductible health plan shall provide coverage for the purchase of a covered prescription asthma inhaler at the lowest deductible and other cost-sharing requirement permitted for a high-deductible health plan under section 223(c)(2)(A) of the Internal Revenue Code (26 U.S.C. s.223). The provisions of this section shall apply to a plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
Nothing in this section shall prevent the State Health Benefits Commission from reducing a covered person's cost-sharing requirement by an amount greater than the amount specified in this section or prevent the commission from utilizing formulary management, including a mandatory generic policy, to promote the use of lower-cost alternative generic drugs that are the therapeutic equivalent of the brand-name drug, which could result in the member's copay being higher than set forth in this section.
(cf: P.L.2023, c.105, s.27)
10. Section 30 of P.L.2023, c.105 (C.52:14-17.46.6u) is amended to read as follows:
30. The School Employees' Health Benefits Commission shall ensure that every contract purchased or renewed by the commission on or after the effective date of P.L.2023, c.105 (C.17:48-6xx et al.), shall provide benefits to a person covered thereunder for expenses incurred for a prescription asthma inhaler, if recommended or prescribed by a participating physician or participating nurse practitioner/clinical nurse specialist. Coverage for the purchase of a covered prescription asthma inhaler shall not be subject to any deductible, and no copayment or coinsurance for the purchase of a covered prescription asthma inhaler shall exceed [$50] $35 per 30-day supply, except a contract provided by the School Employees' Health Benefits Commission that qualifies as a high-deductible health plan shall provide coverage for the purchase of a covered prescription asthma inhaler at the lowest deductible and other cost-sharing requirement permitted for a high-deductible health plan under section 223(c)(2)(A) of the Internal Revenue Code (26 U.S.C. s.223 (c)(2)(A)). The provisions of this section shall apply to a plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
Nothing in this section shall
prevent the School Employees' Health Benefits Commission from reducing a
covered person's cost-sharing requirement by an amount greater than the amount
specified in this section or prevent the commission from utilizing formulary
management, including a mandatory generic policy, to promote the use of
lower-cost alternative generic drugs that are the therapeutic
equivalent of the brand-name drug, which could result in the member's copay being higher than set forth in this section.
(cf: P.L.2023, c.105, s.30)
11. This act shall take effect on the first day of the seventh month next following the date of enactment and shall apply to plans issued or renewed on or after January 1 of the next calendar year, but the Commissioner of the Department of Banking and Insurance may take such anticipatory action in advance thereof as shall be necessary for the implementation of the act.
STATEMENT
This bill reduces the out-of-pocket contribution for any covered person prescribed an asthma inhaler across State-regulated health insurance providers. Current law limits copayments or coinsurance for a 30-day supply of prescription asthma inhalers to $50. Under the bill, copayments or coinsurance for a 30-day supply of prescription asthma inhalers are reduced to $35.
This coverage standard applies to individual or group hospital service corporations, medical service corporations, and health service corporations as well as individual and group health insurance policies and health maintenance organizations. Additionally, the bill extends this coverage standard to individual and small employer health benefits plans and requires that the State Health Benefits Commission and the School Employee's Health Benefits Commission ensure that their contracts comply with this coverage standard.
