ALBANY, N.Y. — With 2026 underway, new health-care laws are now in effect in New York state.
Health insurers will be required to cover medically necessary EpiPens and cap out-of-pocket costs at $100 per year; breast cancer screening and imaging; and the cost of scalp-cooling systems to reduce hair loss during chemotherapy, per the office of Gov. Kathy Hochul.
EpiPens
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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.
This new law 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.
Breast cancer screening and imaging
The new law changes parts of the Insurance Law to require individual, group and nonprofit (including HMO) health-insurance plans to cover breast-cancer screening and diagnostic imaging. This coverage applies if a doctor recommends it based on nationally recognized clinical guidelines.
The screenings include diagnostic mammograms, breast ultrasounds, and MRIs. The new law also clarifies that cost-sharing will not apply to these procedures except to the extent it would result in health savings account ineligibility under IRS guidelines, according to the governor’s office.
Covering cost of scalp-cooling systems
Scalp cooling is covered by Medicaid and Medicare, and three different cooling systems have already been approved by the U.S. Food and Drug Administration. Without insurance coverage, patients must pay out of pocket, which ranges from $1,500 to $3,000 per round of chemotherapy.
The new law requires health insurers in the large group market to provide coverage for scalp cooling systems that are used during chemotherapy treatment, Hochul’s office stated. As part of the treatment, patients wear a cooling cap before, during and after each chemotherapy session to reduce the amount of chemotherapy drugs that reach the hair follicles, which helps to preserve a person’s hair.
