Starting January 1, 2026, New Yorkers will benefit from enhanced health care protections designed to decrease out-of-pocket expenses for essential medical treatments. The new legislation mandates that insurers cover vital services, including EpiPens, breast cancer screenings, and scalp cooling systems for chemotherapy 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 Caps
EpiPens, crucial for treating severe allergic reactions, have become increasingly expensive. The cost for a pack of two pens has surged to approximately $600, a significant rise from around $60 in 2007 when the medication was acquired by Mylan. Given their short shelf life of about 12 months, many patients find themselves replacing these devices annually, with doctors advising that patients carry two pens for safety.
Under the new law, all insurers—whether in the individual or group markets, including non-profit providers and Health Maintenance Organizations (HMOs)—must cover medically necessary EpiPens. Out-of-pocket expenses for these emergency devices will be capped at $100 per year, easing the financial burden on those who rely on them.
Expanded Breast Cancer Screening
Breast cancer is a pressing health issue in New York, with over 17,000 new diagnoses and nearly 2,400 deaths occurring annually. Approximately one in eight women is expected to develop the disease during her lifetime, making it the second leading cause of cancer-related deaths in the state, particularly among women over 50.
The updated legislation ensures that individual, group, and non-profit health plans cover breast cancer screenings and diagnostic imaging, such as mammograms, ultrasounds, and MRIs, when deemed necessary by a physician. Notably, patients will not face cost-sharing for these screenings, with exceptions only for those affecting eligibility for health savings accounts.
Scalp Cooling Coverage for Chemotherapy Patients
Patients undergoing chemotherapy will also see a significant change, as scalp cooling systems are now covered for individuals in larger group insurance plans. These systems, which can cost between $1,500 and $3,000 per treatment cycle without insurance, have been approved by the U.S. Food and Drug Administration. They work by limiting the amount of chemotherapy that reaches hair follicles, enabling patients to maintain their hair during treatment.
This legislative move marks a pioneering step in cancer care, acknowledging that treatment must consider quality of life aspects beyond mere medical intervention. Advocates and lawmakers have highlighted that covering scalp cooling not only preserves patients’ dignity but also alleviates the stress associated with undergoing chemotherapy.
Overall, these new health care laws in New York reflect a broader commitment to improving patient care and addressing financial barriers to essential medical treatments. As these regulations take effect, they will play a crucial role in ensuring that more individuals can access the care they need without the burden of excessive costs.
