Hochul signs legislation to require health insurers to cover EpiPens

Legislation S.7114-A/A.6425-A requires insurers to cover medically necessary EpiPen devices

√ Bill caps out-of-pocket costs, makes life-saving treatment more affordable

Submitted by the Office of Gov. Kathy Hochul

Gov. Kathy Hochul 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 EpiPens, 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 EpiPen device can mean the difference between life and death,” 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.”

EpiPen 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 EpiPen 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 EpiPens once cost $60 per device, they can now sell for upward of $600 for a pack of two pens. EpiPens 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 EpiPens 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 health care 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 nonprofit insurers and HMOs, to cover medically necessary EpiPens 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, “Gov. 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.”

Hochul has made consistent efforts to make health and human services more affordable in New York. She 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. 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.