ALBANY, N.Y. — A new year means new laws in New York State, including several that aim to make medical treatment more affordable.
Starting on Jan. 1, insurers will be required to cover medically necessary EpiPens and to cap out-of-pocket costs at $100 per year for New York residents. Insurers will also be required to cover breast cancer screening and imaging and the cost of scalp cooling systems to reduce hair loss during chemotherapy. Here’s what to know.
EpiPen coverage
The new law aims to expand access to EpiPens, used to treat life-threatening allergic reactions caused by insect stings, foods, medications, and environmental exposures. The state says the cost of the EpiPen has far outpaced the rate of inflation, with some reports citing a 600% increase in price since 2007. While EpiPens once cost $60 per device, they can now sell for upwards of $600 for a pack of two pens.
EpiPens typically expire after 12 months, meaning people with allergies still need to buy new ones even if their current EpiPen hasn’t been used. The new EpiPen coverage law applies to all insurers in individual and group markets, including non-profit insurers and HMOs.
Breast cancer screening coverage
The new law requires individual, group, and non-profit (including HMO) health insurance plans to cover breast cancer screening and diagnostic imaging. This coverage applies if a doctor recommends screening based on nationally recognized clinical guidelines.
The screenings include diagnostic mammograms, breast ultrasounds, and MRIs. The new law also clarifies that cost-sharing won’t apply to these screenings, except to the extent it would result in health savings account ineligibility under IRS guidelines.
Each year, at least 17,000 women in New York State are diagnosed with breast cancer and nearly 2,400 women die from the disease. It’s estimated that one in eight women will develop breast cancer during their life.
Scalp cooling systems coverage
The new law requires health insurers in the large group market to cover scalp cooling systems used to reduce hair loss during chemotherapy treatment. As part of the treatment, patients wear a cooling cap before, during, and after each chemotherapy session. That reduces the amount of chemotherapy drugs that reach the hair follicles, which helps to preserve hair.
Scalp cooling is covered by Medicaid and Medicare and three different cooling systems have been approved by the FDA. Without insurance coverage, patients must pay out of pocket for cooling, which ranges from $1,500 to $3,000 per round of chemotherapy.
Guide to New York State health care laws that go into effect in 2026 WHEC.com.
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