Money in Your Pockets: Governor Hochul Signs Legislation to Require Health Insurers to Cover EpiPens

Money in Your Pockets: Governor Hochul Signs Legislation to Require Health Insurers to Cover EpiPens

Governor Kathy Hochul today signed legislation that will reduce the sky-high costs of epinephrine auto-injector ("EpiPen") devices for consumers with commercial health insurance and expand access to critical health care resources for individuals with allergies. The legislation will require health insurers to cover Epi-Pens and caps the amount consumers will be required to pay out-of-pocket at $100, making the lifesaving treatment more affordable for the New Yorkers who need it.

"For people with severe allergies, immediate access to an Epi-Pen device can mean the difference between life and death," Governor Hochul said. "When every second counts, the last thing New Yorkers should have to worry about is whether they can afford the medication they need to survive an anaphylactic reaction. By signing this bill, we are putting people over profit and giving New Yorkers peace of mind by ensuring equitable access to this lifesaving emergency treatment."

Epi-Pen devices are used to treat life-threatening allergic reactions in individuals who are at risk or have a history of anaphylaxis, which can be caused by insect bites or stings, foods, medications, environmental exposures, exercise and other unknown causes.

The cost of Epi-Pen devices has far outpaced the rate of inflation, with some reports citing a 600% increase in price since the medication was first acquired by Mylan in 2007. While Epi-Pens once cost $60 per device, they can now sell for upwards of $600 for a pack of two pens. Epi-Pens have a relatively short shelf-life, expiring after 12 months on average, requiring those in need to purchase the medication repeatedly. Adding to their expense, users of Epi-Pens are also advised to carry two devices at all times, as a single dose of epinephrine may not be enough to treat a serious allergic reaction. Acquiring the devices requires a prescription from a healthcare provider. Due to the rising costs, many who are prescribed the auto-injectors, try to stretch out their supply by going beyond expiration dates or delaying picking up their prescriptions.

Legislation S.7114-A/A.6425-A will dramatically reduce the cost of these devices for consumers by requiring health insurers in the individual and group markets, including non-profit insurers and HMOs, to cover medically necessary Epi-Pens for the emergency treatment of allergic reactions and cap out-of-pocket costs for such coverage at $100 per year.

New York State Health Commissioner Dr. James McDonald said, "Governor Hochul understands that for too long, skyrocketing costs have increasingly become a barrier to these lifesaving medications. By capping the out of pocket costs of medically necessary EpiPen devices, more New Yorkers who are at risk of severe allergic reactions will have access to the medications they need if an emergency arises."

State Senator Gustavo Rivera said, "I'm incredibly proud that my bill that requires insurance plans to limit the annual out of pocket costs for EpiPens to $100 is now state law. It is unacceptable that so many people are forced to risk not having the device during a life-threatening emergency due to prohibitive costs. After capping the cost of insulin last year, it's clear that access to life-saving medication should not be based on income level. I want to thank Governor Hochul for signing such an important bill into law, and it is my hope that we can continue to pass similar measures that will make health care more accessible to all New Yorkers."

Assemblymember Daniel J. O'Donnell said, "By enacting my bill, A.6425-A/S.7114-A: The Epinephrine Coverage and Affordability Act, New York remains a leader in providing life-saving medicine to our most vulnerable communities. For 15 years, the cost of EpiPens has skyrocketed, placing unreasonable burdens on many families. I want to thank Governor Hochul and my counterpart, Senator Gustavo Rivera- today, we have made a meaningful difference in the lives of New Yorkers. Today we reaffirm, financial means should never be a barrier to life-saving healthcare."

Governor Hochul has made consistent efforts to make health and human services more affordable in New York State. Governor Hochul has signed legislation to eliminate insulin cost-sharing for any New Yorker on a State-regulated health insurance plan, the most expansive prohibition against insulin cost-sharing in the nation, Governor Hochul has prioritized affordability for families and parents by investing $1.8 billion in child care in the past year alone. New York has also received a final commitment of $10 billion from the federal government to provide high-quality, affordable health insurance to approximately 1.5 million New Yorkers. Following sustained advocacy by the Governor, New York secured this funding through the federal State Innovation Waiver, marking the nation's largest award to date. This advancement lowered New Yorkers premiums and health care costs.

This legislation builds on the Governor's commitment to strengthening the state's health care system and improving access for all New Yorkers. The Governor's FY 2025 Enacted Budget included $20 million to continue expanding school-based mental health clinic satellites, $19 million to provide critical care to young people outside of school environments, $33 million to build supports for individuals living with a mental illness who are involved in the criminal justice system, and $55 million to add 200 inpatient beds at state-operated psychiatric centers. Earlier this month, Governor Hochul kicked off a statewide campaign to raise awareness of New York's first-in-the-nation paid prenatal leave policy, which takes effect on January 1, 2025. This nation-leading policy, proposed in Governor Hochul's 2024 State of the State and signed into law in April, gives workers the ability to take paid leave for any pregnancy-related medical appointments.