New health care regulations in New York will provide substantial protections for patients, beginning on January 1, 2026. The newly enacted law introduces mandates for health insurers to cover critical medical services and devices aimed at reducing out-of-pocket expenses for patients. 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.”
EpiPen Coverage and Cost Cap Implementation
One of the key provisions of the new law is the requirement for insurers to cover medically necessary EpiPens, which are essential for treating severe allergic reactions. Over the last decade, the cost of EpiPens has surged, with a pack of two now priced at around $600, a significant increase from approximately $60 when the medication was acquired by Mylan in 2007. Given their limited shelf life of about 12 months, many patients must replace them annually, and medical professionals often recommend carrying two pens for safety.
Under the new regulations, insurers across both individual and group markets—including non-profit providers and health maintenance organizations (HMOs)—must cover these life-saving devices. Importantly, patients will face a cap on out-of-pocket costs for EpiPens, limited to $100 per year.
Expanded Breast Cancer Screening Coverage
Breast cancer remains a critical health issue in New York, with over 17,000 new diagnoses and nearly 2,400 deaths each year. The updated law addresses this pressing concern by mandating coverage for breast cancer screening and diagnostic imaging. This includes essential procedures such as mammograms, ultrasounds, and MRIs when prescribed by a physician according to established clinical guidelines.
Cost-sharing will be waived for these services, except in scenarios that might affect eligibility for health savings accounts. With one in eight women likely to develop breast cancer in their lifetime, these enhancements in coverage are poised to make a significant difference in early detection and treatment.
Insurance Coverage for Scalp Cooling Systems
Another groundbreaking aspect of the legislation is the inclusion of coverage for scalp cooling systems used during chemotherapy. These systems help mitigate hair loss, a common side effect of cancer treatment. Without insurance, the cost of chemotherapy combined with scalp cooling can range from $1,500 to $3,000.
The U.S. Food and Drug Administration has approved three different cooling systems designed to reduce the amount of chemotherapy reaching hair follicles, thus allowing patients to maintain some normalcy during treatment. This law represents a pioneering effort in the United States, highlighting the need for cancer care to encompass more than just medical interventions. Lawmakers and patient advocates have stressed that providing coverage for scalp cooling not only preserves dignity but also alleviates stress for individuals facing the challenges of chemotherapy.
As these new laws take effect, they promise to improve health care accessibility and affordability for many New Yorkers, reflecting a broader commitment to enhancing patient care and outcomes in the state.
