New health care laws in New York will introduce vital protections aimed at reducing out-of-pocket costs for essential medical care starting on January 1, 2026. These new regulations mandate that insurers provide coverage for medically necessary EpiPens, expand breast cancer screening and imaging services, and include insurance for scalp cooling systems used during chemotherapy. Governor Kathy Hochul emphasized the importance of these changes, stating, “New Yorkers shouldn’t have to choose between putting food on the table or being able to afford life-saving medical devices and procedures.”
Expanded Coverage for EpiPens
EpiPens, which are crucial for treating severe allergic reactions, have long posed a financial challenge for many patients. Over the past decade, prices have surged, with a pack of two pens now costing around $600, a stark increase from approximately $60 in 2007 when the medication was acquired by Mylan. Due to their short shelf life of about 12 months, many patients are required to replace them annually, and health professionals recommend carrying two pens for emergencies.
The new legislation will require insurers in the individual and group markets, including non-profit providers and health maintenance organizations (HMOs), to cover medically necessary EpiPens for emergency allergic reactions. Patients will now face a cap on out-of-pocket expenses for these devices at $100 per year.
Enhancements in Breast Cancer Screening
Breast cancer remains one of the most prevalent forms of cancer among women in New York, with over 17,000 new diagnoses and nearly 2,400 deaths each year. One in eight women is expected to develop breast cancer during her lifetime, making it the second leading cause of cancer-related deaths in the state, particularly among those over 50.
Under the revised law, individual, group, and non-profit health plans will now be required to cover breast cancer screening and diagnostic imaging, including mammograms, ultrasounds, and MRIs, provided that these are recommended by a physician following established clinical guidelines. Importantly, there will be no cost-sharing for these services, except in specific cases that may affect eligibility for health savings accounts.
Insurance Coverage for Chemotherapy Scalp Cooling
In a significant move for cancer care, the new law also mandates coverage for scalp cooling systems used during chemotherapy in the large group insurance market. These systems can help mitigate hair loss, which is a common side effect of chemotherapy, significantly impacting the emotional well-being of patients. The cost of a chemotherapy session accompanied by scalp cooling can range between $1,500 and $3,000 without insurance.
The U.S. Food and Drug Administration has approved three different scalp cooling systems that function by limiting the amount of chemotherapy that reaches hair follicles, allowing patients to maintain their hair and a sense of normalcy throughout treatment. This legislation is the first of its kind in the nation, highlighting an evolving understanding that effective cancer care must address the physical and emotional needs of patients.
Lawmakers and advocates have stressed that covering scalp cooling not only helps preserve dignity but also alleviates the stress experienced by patients undergoing chemotherapy, marking a significant step forward in comprehensive cancer treatment.