BILL NUMBER: S1917
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the public health law and the state finance law, in
relation to an emergency insulin program
 
PURPOSE:
The purpose of this bill is to establish an emergency insulin program
 
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 amends the Public Health Law by adding a new article 28-CC as
it relates to establishing an emergency insulin program. This section
would allow the Commissioner of Health to establish an emergency insulin
program to ensure that recipients of the program can access emergency
supplies of analog insulin and other related supplies. The Commissioner
would establish standards for the program that include analog insulin
prescribing, dispensing, distribution, and possession. Analog insulins,
health care professionals, pharmacist, and recipient are all defined in
this section for the purposes of this article. The use or dispensing of
analog insulin, in accordance with this section, would be considered
first aid or emergency treatment for the purpose of any statute relating
to liability.
Section 2 amends the Finance Law by adding a new section 95-1 as it
relates to the emergency insulin program trust fund. The emergency insu-
lin fund would be established in the joint custody of the State Comp-
troller and the Commissioner of Taxation and Finance to support the
emergency insulin program and fund emergency access to analog insulin.
Section 3 provides the effective date.
 
JUSTIFICATION:
In December 2022, Governor Kathy Hochul declared a diabetes health emer-
gency in New York State to tackle an epidemic that affects over 2
million state residents, and in the SFY 2024-25 budget we completely
eliminated cost sharing for insulin. When not managed properly, diabetes
can have serious and debilitating health effects, including heart
disease, kidney failure, blindness, and lower limb amputation. Severe
complications of diabetes include Diabetic Ketoacidosis, also referred
to as DKA, and even death. In recent years, New York has seen a signif-
icant increase in leg and foot amputation and eye disease. In New York
City alone, there was a 356% increase in diabetes-related deaths during
the early months of the COVID-19 pandemic.
Diabetes management is important in preventing further complications.
Type 1 and some Type 2 diabetics depend upon insulin for their survival.
The recent increase in the cost of insulin made it difficult for some
diabetics to obtain their necessary medication. When patients can't
afford insulin, which can cost thousands of dollars even for those who
are insured, they have resorted to rationing the little medication they
can afford. In fact, one study found that 20 percent of people under the
age of 65 diagnosed with diabetes admitted to not taking their insulin
as prescribed, or rationing, due to the cost.
This legislation creates an Emergency Insulin Program, modeled after New
York State's Opioid Overdose Prevention Program which has expanded
access to life-saving Naloxone to reverse an opioid overdose widely
available in our state. Under the Emergency Insulin Program, individuals
who are uninsured or underinsured would be able to get analog insulin
through a non-patient specific prescription at certain pharmacies,
including clinic and hospital pharmacies. The Department of Health (DOH)
would be able to establish a sliding scale for certain cost sharing,
which would be capped at $100 per month for a thirty-day supply of insu-
lin and supplies.
The bill directs DOH to immediately engage analog insulin manufacturers
to support the state program and facilitate quick access to affordable
analog insulin in emergency situations through a public private partner-
ship to streamline existing patient support programs such manufacturers
have. The three manufacturers of analog insulin each have programs
designed to help people access their products at a reduced rate or for
free, however, each program is different and advocates argue that they
are difficult to access, especially in emergency situations. Recognizing
that manufacturers want to make sure everyone can access the life-saving
medications they offer to patients, this bill establishes an Emergency
Insulin Program Trust fund to accept funds for the statewide program.
Like New York's highly successful Opioid Overdose Prevention Program,
this program would allow for non-patient specific prescriptions for
analog insulins and utilize chain pharmacies and 340B pharmacies, which
are able to provide the lowest cost medications, to distribute the insu-
lins and supplies to recipients who qualify.
While it is true there are some types of human insulin that can be
accessed over the counter and for a relatively low fee, these are often
referred to as "dead in bed" insulin because they do not provide the
level of support many type 1 and some type 2 diabetics require. These
low cost human insulins are less commonly prescribed by doctors precise-
ly because of their unpredictable rate of absorption, which can result
in more frequent low and high blood sugars. They require more monitoring
and more supplies and, according to advocates, when people transition
from the newer and more costly analog insulins the risk of "dead in bed"
syndrome is greatly increased.
In recent years, the Opioid Overdose Prevention Program has been
expanded to provide access to life-saving medication in pharmacies, not
just through community-based organizations. Like overdose, the risk of
death from a lack of insulin occurs far too often and quickly. New York
State must do all it can to make sure that diabetics who depend on insu-
lin for their survival can access emergency supplies of analog insulin,
just as we currently ensure that friends, families, and first responders
are equipped with life-saving naloxone in case of an overdose. There is
no question that a person who depends on daily insulin for their
survival is at grave risk without timely access to affordable insulin.
Nobody should die from rationing or running out of insulin, or from
being forced to switch to less reliable human insulin. The Emergency
Insulin Program can make sure New York, with the cooperation of manufac-
turers of analog insulins, is doing all it can to ensure those in need
can access this life-saving medication.
 
LEGISLATIVE HISTORY:
2019-2020: S7771/A10054 Gottfried
2021-2022: S4883/A194 Gottfried
2023-2024: S3222/A7853 Cunningham
 
FISCAL IMPLICATIONS:
To be determined, but potential savings as expensive hospitalizations as
a result of severe adverse reactions from patients rationing or running
out of insulin are avoided.
 
EFFECTIVE DATE: Effective immediately.