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CA

Bill

S 3818

Requires third-party discounts and payments for individuals covered by health benefits plans to apply to copayments, coinsurance, deductibles, or other out-of-pocket costs for covered benefits.

2024-2025 Regular Session Introduced by Carmen Amato and 7 co-sponsors

New Jersey law would require health insurers to allow third-party discounts and payments to reduce patients' copays, coinsurance, and deductibles rather than bypassing them.

Senate Amendment (Voice) (Ruiz)
#healthinsur
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WeVote Research Nonpartisan
Bill Summary · S 3818

Legislative bill overview

S 3818 requires that third-party discounts and payments (such as manufacturer coupons, patient assistance programs, or discount cards) must be applied directly to reduce a patient's out-of-pocket costs like copayments, coinsurance, and deductibles. Currently, some health insurers may not allow these third-party payments to count toward patient cost-sharing obligations, effectively negating their value for insured individuals.

Why is this important

This bill directly affects medication and healthcare affordability for New Jersey residents. By mandating that third-party discounts reduce actual out-of-pocket spending, patients could save hundreds or thousands of dollars annually on prescriptions and treatments. The policy also addresses a disconnect where patients hold valid discount vouchers but insurers prevent them from using them, creating frustration and potentially discouraging use of cost-saving programs.

Potential points of contention

  • Insurance industry concerns: Insurers may argue this reduces their ability to manage costs and could increase premiums overall by reducing cost-sharing incentives that discourage unnecessary utilization
  • Deductible application debate: Disagreement over whether third-party payments should count toward deductible satisfaction (which could delay insurers' cost-sharing obligations) or only apply after deductibles are met
  • Pharmaceutical manufacturer relationships: Manufacturers and pharmacy benefit managers may have concerns about how discount programs interact with formulary designs and rebate structures they've negotiated with insurers

Compiled from official sources — confirm details with the bill’s official record.

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