New N.Y. law mandates health insurers cover epipens; out-of-pocket costs will be limited

STATETEN ISLAND Governor Kathy Hochul of New York signed legislation on Thursday mandating that health insurance in the state of New York fund epipens for individuals who require them and cap the annual out-of-pocket expenses at $100.

With resounding bipartisan support, the bill passed the state legislature earlier this year and would mandate that health insurance companies pay at least two medically necessary epinephrine auto-injectors beginning on January 1, 2026.

According to Hochul, having instant access to a [epipen] device can make the difference between life and death for those with severe allergies. The last thing New Yorkers should have to worry about when time is of the essence is whether they can afford the drugs they need to survive an anaphylactic reaction. We are prioritizing people over business by signing this law, which will provide New Yorkers with piece of mind by guaranteeing fair access to this life-saving emergency care.

In medical crises involving allergic reactions, epipens can be used to treat anaphylaxis.

In recent years, the cost of life-saving equipment has skyrocketed, forcing those who require it to spend hundreds of dollars and occasionally restricting their supply, which keeps epipens past their expiration date.

Packages of two can cost up to $600, and because they only last for approximately a year, consumers are frequently compelled to pay the outrageous fees every year.

For 15 years, the cost of [epipens] has skyrocketed, placing unreasonable burdens on many families, Assemblyman Daniel O Donnell (D-Manhattan), the sponsor of the bill, said. We emphasize today that access to life-saving medical care should never be impeded by financial constraints.

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Hochul signed legislation earlier this year that removed the cost-sharing of insulin for New Yorkers enrolled in state-regulated health insurance programs.

The Senate sponsor of the bill signed Thursday, State Senator Gustavo Rivera (D-Bronx), stated that both measures would contribute to the affordability of healthcare in New York.

The fact that my measure, which mandates that insurance companies cap the annual out-of-pocket expenses for EpiPens at $100, has become state law makes me quite proud. He said it is intolerable that so many individuals must risk not having the equipment in a life-threatening situation because of excessive costs. It’s obvious that access to life-saving medication shouldn’t be determined by one’s financial level after the cost of insulin was capped last year.

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