New Jersey adopts final rules capping copays for insulin, EpiPens and asthma inhalers
TRENTON, N.J. — The New Jersey Department of Banking and Insurance has adopted final regulations requiring state-regulated health insurers to cap out-of-pocket costs for insulin, epinephrine auto-injector devices and asthma inhalers, part of the Murphy administration’s ongoing effort to improve drug price transparency and make health care more affordable.
The rules implement a law signed by Gov. Phil Murphy that made New Jersey the second state in the nation to cap costs for inhalers and EpiPens in addition to insulin. Guidance was issued to insurers last year and the caps have already taken effect.
“Improving health care affordability and accessibility have been hallmarks of my Administration. No one should be without access to medications that can improve their lives,” Murphy said. “Capping the costs of these critical prescriptions such as inhalers and EpiPens can have lifesaving consequences for those who depend on them.”
The law extends Medicare’s $35 monthly insulin cap to state-regulated insurance markets and New Jersey public employee plans, including Get Covered New Jersey, the state’s official health insurance marketplace. Under the statute, out-of-pocket costs are capped at $25 for a month’s supply of epinephrine auto-injector devices and $50 for asthma inhalers.
“New Jersey has made great progress expanding access to quality, affordable health insurance through Get Covered New Jersey, and this law builds on our efforts by capping the out-of-pocket costs of vital medications through all marketplace plans,” Banking and Insurance Commissioner Justin Zimmerman said. “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. Consumers should enroll by December 31 for January 1 coverage.”
Open enrollment for 2026 coverage runs from Nov. 1, 2025, through Jan. 31, 2026. Consumers who want coverage to begin Jan. 1 must enroll by Dec. 31; those who enroll by Jan. 31 will have coverage starting Feb. 1.
Under P.L. 2023, Chapter 105, which took effect Jan. 1, 2025, fully insured carriers—including those in the individual and small employer markets—must offer certain medications without a deductible and may not charge payments or coinsurance exceeding the statutory caps.
The $35 monthly cap applies to any insulin product prescribed as part of a 30-day supply, regardless of the type or number of prescriptions. Coverage is also required for diabetes-related equipment, supplies and self-management education.
Insurers must limit out-of-pocket costs for asthma inhalers to $50 per 30-day supply, and must cover at least one epinephrine auto-injector device with a $25 monthly limit.
The regulations also implement provisions of Grace’s Law (P.L. 2023, Chapter 275), requiring insurers to cover hearing aids or cochlear implants, eliminate age restrictions, remove the previous $1,000 coverage cap, and expand coverage to one device per hearing-impaired ear every 24 months. Out-of-pocket costs are limited to those associated with primary care visits and hearing aids, which cannot be classified as durable medical equipment for cost-sharing purposes.
The Department of Banking and Insurance worked with the Governor’s Office of Health Care Affordability and Transparency in developing the regulations, which were published in the New Jersey Register on Dec. 1, 2025.
