New legislation will provide New Yorkers with enhanced health care protections designed to reduce out-of-pocket expenses for essential medical services starting January 1, 2026. The new regulations mandate that insurance companies cover medically necessary EpiPens, broaden breast cancer screening and imaging services, and extend coverage for scalp cooling systems used during chemotherapy. New York 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 Controls
EpiPens, essential for treating severe allergic reactions, have become a significant financial burden for many patients. The cost of a two-pack has surged to approximately $600, a sharp increase from around $60 when the medication was acquired by Mylan in 2007. Given their limited shelf life of around 12 months, many patients need to replace these devices annually, and healthcare providers typically recommend carrying two pens.
Under the new legislation, insurers in both individual and group markets, including non-profit organizations and health maintenance organizations (HMOs), will be required to cover medically necessary EpiPens for emergency allergic reactions. Importantly, patients’ out-of-pocket expenses for these devices will be limited to $100 per year.
Expanded Breast Cancer Screening Services
Breast cancer is a pressing health issue in New York, with over 17,000 diagnoses and nearly 2,400 deaths reported annually. The disease is expected to affect one in eight women during their lifetime, making it the second leading cause of cancer-related mortality in the state, particularly among women over 50.
The revised law ensures that health plans covering individuals, groups, and non-profit organizations will include breast cancer screenings and diagnostic imaging—such as mammograms, ultrasounds, and MRIs—when prescribed by a physician in accordance with established clinical guidelines. Cost-sharing will not apply, except in situations affecting eligibility for health savings accounts.
Insurance for Scalp Cooling During Chemotherapy
The new legislation also marks a significant development for chemotherapy patients by mandating coverage for scalp cooling systems in large group insurance plans. These systems, which can cost between $1,500 and $3,000 without insurance, help mitigate hair loss during chemotherapy by cooling the scalp and reducing the amount of chemotherapy that reaches hair follicles.
Approved by the U.S. Food and Drug Administration, these systems address not only the medical aspects of cancer treatment but also the emotional well-being of patients. Advocates for the legislation highlighted that providing coverage for scalp cooling helps maintain dignity and alleviates some of the stress associated with undergoing chemotherapy.
This new health care law represents a significant step in supporting patients across New York, reflecting a growing recognition that comprehensive cancer care must encompass both medical treatment and the quality of life for patients.
