ALBANY, N.Y. — Starting Jan. 1, New Yorkers with allergies or facing a cancer diagnosis will see some financial relief, as several new state laws aim to lower healthcare costs. Insurers will now be required to cap out-of-pocket expenses for EpiPens at $100 annually and fully cover medically necessary breast cancer screenings and scalp cooling systems during chemotherapy.
EpiPen Coverage: A Lifeline Within Reach
The new law expands access to EpiPens, essential for treating severe allergic reactions, by capping annual out-of-pocket costs at $100.
For those living with potentially life-threatening allergies to insect stings, foods, medications, or environmental factors, EpiPens are a necessity. But the cost has skyrocketed in recent years. The state reports the price of an EpiPen has increased by as much as 600% since 2007, jumping from around $60 per device to over $600 for a two-pack. Because EpiPens expire after 12 months, even unused devices must be replaced regularly, adding to the financial burden. The new law applies to all insurers in the individual and group markets, including non-profit insurers and HMOs.
Breast Cancer Screening: Early Detection, No Extra Cost
Early detection is key in the fight against breast cancer, and New York is making it more accessible. The new law mandates that individual, group, and non-profit health insurance plans – including HMOs – cover breast cancer screening and diagnostic imaging when recommended by a doctor based on nationally recognized clinical guidelines.
Covered screenings include diagnostic mammograms, breast ultrasounds, and MRIs. Importantly, cost-sharing for these screenings is prohibited, except where it would jeopardize eligibility for a health savings account under IRS rules. Each year, at least 17,000 women in New York State are diagnosed with breast cancer, and nearly 2,400 die from the disease. Statistics show that approximately one in eight women will develop breast cancer during their lifetime.
Scalp Cooling Systems: Preserving Dignity During Chemotherapy
Chemotherapy can take a significant emotional toll, and hair loss is a particularly distressing side effect for many patients. New York’s latest legislation aims to alleviate this concern by requiring large group market health insurers to cover scalp cooling systems used to reduce hair loss during chemotherapy treatment.
These systems involve wearing a cooling cap before, during, and after each chemotherapy session, reducing the amount of chemotherapy drugs reaching hair follicles and helping to preserve hair. Scalp cooling is already covered by Medicaid and Medicare, and three different systems have received FDA approval. Without insurance coverage, patients typically face out-of-pocket costs ranging from $1,500 to $3,000 per round of chemotherapy.
What screenings are covered under the new breast cancer law? Diagnostic mammograms, breast ultrasounds, and MRIs are all covered when recommended by a doctor following nationally recognized clinical guidelines.
- Starting January 1, New York insurers must cap EpiPen out-of-pocket costs at $100 per year.
- The new law ensures full coverage for medically necessary breast cancer screenings and diagnostic imaging.
- Large group market insurers are now required to cover scalp cooling systems during chemotherapy.
