BILL NUMBER: S7114A
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the insurance law, in relation to requiring health
insurance plans to provide coverage for epinephrine auto-injector
devices
 
PURPOSE OR GENERAL IDEA OF BILL:
To require insurance coverage for epinephrine auto-injectors ("epipens")
and set an annual cost-sharing cap.
 
SUMMARY OF PROVISIONS:
Section 1 amends subsection (i) of section 3216 of the insurance law, as
it relates to individual accident and health insurance policy
provisions, by adding a new paragraph 39 to require insurance coverage
of epinephrine auto-injectors. The language includes an exemption for
certain high deductible plans to comply with federal law.
Section 2 amends subsection (k) of section 3221, as it relates to group
or blanket accident and health insurance policies of the insurance law,
by adding a new paragraph 23 that provides coverage requirements and a
maximum copayment of $100 annually for two epinephrine auto-injector
devices. The language includes an exemption for certain high deductible
plans to comply with federal law.
Section 3 amends section 4303 of the insurance law by adding a new
subsection (vv) to provide coverage requirements and maximum copayment.
The language includes an exemption for certain high deductible plans to
comply with federal law.
Section 4 provides the effective date.
 
JUSTIFICATION:
The rising cost of an epinephrine auto-injector, or "epi-pen," has far
outpaced inflation in recent years. Without mandated coverage and a
reasonable cost-sharing cap, the accessibility of these life-saving
devices are beyond the means of millions of New Yorkers.
In 2010, the most common price for a two-pack of epi-pens was approxi-
mately $100. Today, the generic version will almost always cost upwards
of $350 and the brand name can cost upwards of $700. It is unacceptable
that so many people are forced to risk not having the device during a
life-threatening emergency due to the prohibitive cost.
Separate studies by the National Institutes of Health (NIH) and Blue
Cross Blue Shield showed that emergency room visits by children having
serious anaphylactic reactions have more than doubled during the 2010s,
the same timeframe during which epi-pen prices began to skyrocket. An
epinephrine auto-injector significantly mitigates the risk of death from
a serious allergic reaction.
By mandating insurance plans to provide coverage for epi-pens and
capping the annual cost at $100 for two pens, these life-saving devices
will be more widely accessible for those who need them. Access to
essential medication should not be contingent on income level.
 
PRIOR LEGISLATIVE HISTORY:
New Bill.
 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
None.
 
EFFECTIVE DATE:
Immediately

Statutes affected:
S7114: 3221 insurance law, 3221(k) insurance law, 4303 insurance law
S7114A: 3221 insurance law, 3221(k) insurance law, 4303 insurance law