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Prescription Caps For Some Products To Begin Soon In NJ
New Jersey will limit monthly out-of-pocket costs for insulin to $35, inhalers to $50, and
EpiPens to $25 beginning January 1, 2025, reports Patch. This legislation follows growing
concerns about prescription drug affordability. According to a 2023 study, more than half of
New Jersey residents said they are “somewhat worried” or “very worried” about the price of
prescription drugs. About one in four respondents also reported that they were recently forced
to skip a prescription, cut pills in half, or skip a dose because of cost.
DC Waives Cost of Care for People with HIV
Beginning January 1, 2026, D.C. Health Link will provide comprehensive, cost-free coverage
for individuals with HIV, including primary care visits, laboratory testing, and generic HIV
medications, reports Washington Blade. This enhanced benefit structure will eliminate
deductibles, co-insurance, and co-pays for covered services. While PrEP is already included in
existing coverage, the expanded offering aims to further improve health outcomes by reducing
financial barriers to essential HIV care.
Nearly Half of CO Hospitals Violate Federal Price Transparency Rules
Fourteen Colorado hospitals, including all Intermountain Health and AdventHealth locations in
the state, failed to meet federal hospital price transparency rules, reports Westword. Both
federal and state law mandate hospitals disclose estimated and actual costs, respectively. The
noncompliance highlights ongoing gaps in price transparency enforcement at the state level.
CT OHS Releases Study Assessing Behavioral Health Parity
The Connecticut Office of Health Strategy (OHS) has published a report exploring disparities in
reimbursement between physical, mental, and behavioral health services, reports
the Connecticut Office of Health Strategy. The study found that Medicare Advantage rates for
psychiatry were significantly lower than for other specialties. Additionally, four major insurers,
including Anthem and United Healthcare, showed evidence of payment gaps between
behavioral and medical services.
CA Establishes 15% Primary Care Spending Target
The California Office of Health Care Affordability has increased the state’s primary care
spending target from 7% to 15%, reports the San Francisco Chronicle. Insurance carriers will
have until 2034 to meet the target. The initiative seeks to strengthen preventive care access
and expand the primary care workforce. Officials hope increased investment will enhance
health management and early disease detection.
Uncompensated Care Increases in WI
Uncompensated care at Wisconsin hospitals increased 6% in 2023 to $1.36 billion,
reports Wisconsin Public Radio. Bad debt, where patients cannot pay but do not seek financial
aid, accounted for $731.6 million, while charity care rose nearly 8%. The end of pandemic-era
Medicaid enrollment policies left more residents uninsured or underinsured. However,
hospitals report that even insured patients are struggling with affording care due to high
deductibles, intensifying financial pressures on the health system.
Health System Consolidation Raising Prices, Increasing Debt in NJ
Hospital consolidation in New Jersey results in higher costs of care the increases the amount
of medical debt among residents, reports NJ Advance Media. Despite federal attempts to limit
the number of health system mergers, these transactions continue to occur in increasing
numbers. State efforts to address the issue include laws targeting prescription drug pricing and
the Louisa Carman Medical Debt Relief Act, signed by Governor Murphy in 2024.
MD to Cap Out-of-Pocket Costs for Certain Prescription Drugs
Maryland’s Prescription Drug Affordability Board received approval to cap costs for certain
prescription drugs under state and local health plans, reports AARP Maryland. The board will
review six high-cost medications, including Ozempic and Dupixent, to determine affordability
and potential savings. Caps will be imposed only if they lower costs without reducing access.
The plan marks Maryland’s latest effort to rein in rising drug prices.
Rhode Island Launces Medical Debt Initiative
An average of 5.2 percent of Rhode Island adults report having medical debt in a given year,
reports the Boston Globe. To address this issue, the state is launching a medical debt
cancellation program, purchasing debt from providers and collectors to relieve residents with
income at or below 400% of the federal poverty level or with debt exceeding 5% of income.
Cancellation will occur automatically, with no need for impacted individuals to apply.
Black Women in OH Face Barriers to Health Care
A recent report shows many of Ohio’s Black women worry about health insurance affordability,
discrimination and other issues when seeking health care, reports Spectrum News
1. According to the survey of Black women from Policy Matters Ohio, respondents reported
delayed or skipped care due to the high costs of tests (44.7%), visits (37.8%), and medications
(43.7%), and 56.3% experienced stress due to medical debt. In addition, nearly half reported
feeling discriminated against based on race, while nearly one third reported feeling
discriminated against based on gender and age, respectively.
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