The New Jersey Department of Banking and Insurance (DOBI) has adopted final regulations that establish strict caps on out-of-pocket costs for critical prescription medications, including insulin, epinephrine auto-injector devices (EpiPens), and asthma inhalers.
The announcement, made on Tuesday, represents the final regulatory step in implementing legislation previously signed by Gov. Phil Murphy. These rules apply to department-regulated health insurance markets and public employee plans.
With these regulations, New Jersey officially becomes the second state in the nation to cap out-of-pocket costs for asthma inhalers and EpiPens, in addition to insulin.
“Improving health care affordability and accessibility have been hallmarks of my Administration,” Murphy said. “No one should be without access to medications that can improve their lives. Capping the costs of these critical prescriptions… can have lifesaving consequences for those who depend on them.”
Key Price Caps Effective January 1, 2025
Under the final regulations, carriers in the fully insured market—including individual and small employer markets—must provide these medications without requiring patients to meet a deductible first. Consumer payments are capped at the following amounts per 30-day supply:
| Medication | Statutorily Required Cap (per 30-day supply) |
| Insulin | $35 |
| Epinephrine Auto-Injectors (e.g., EpiPens) | $25 |
| Asthma Inhalers | $50 |
The $35 insulin cap applies to any prescribed insulin product, regardless of the type or number of prescriptions needed by the patient. Furthermore, the $50 asthma inhaler cap applies regardless of the type of inhaler prescribed.
Expanded Coverage for Hearing Aids
Consistent with P.L. 2023, Chapter 275, also known as Grace’s Law, the regulations include expanded requirements for hearing aid coverage:
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No Age Limit: Coverage is required for hearing aids or cochlear implants without restriction on the patient’s age.
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Enhanced Benefits: The previous $1,000 limit on coverage has been removed.
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Frequency: Coverage expands to one hearing aid for each hearing-impaired ear every 24 months.
Open enrollment and ‘Get Covered NJ’
DOBI Commissioner Justin Zimmerman highlighted that these caps are built into all plans available through Get Covered New Jersey, the state’s official health insurance marketplace.
“With Open Enrollment underway at Get Covered New Jersey, we encourage consumers who need health insurance with prescription coverage to visit GetCovered.NJ.gov to explore plan options,” Commissioner Zimmerman said.
