New Laws in New York Force Insurers to Cover Pricey EpiPens and Cancer Care

Three new laws in New York that took effect January 1 are forcing health insurers to cap costs for life-saving EpiPens and cover expensive cancer treatments, providing financial relief for residents but raising industry concerns about rising premiums.

• A shot of relief: For anyone with a life-threatening allergy, the annual out-of-pocket cost for EpiPens is now capped at $100. The move provides a ceiling for a device whose price has soared by 600% to over $600 for a two-pack in recent years. "New Yorkers shouldn’t have to choose between putting food on the table or being able to afford life-saving medical devices and procedures," Governor Kathy Hochul said in a statement.

• Targeting cancer costs: The state is also taking aim at the high costs of cancer care. Insurers must now cover doctor-recommended breast screenings with no out-of-pocket costs, and large-group plans must now pick up the tab for scalp cooling systems—a treatment to prevent hair loss that can run from $1,500 to $3,000 per round.

• The fine print: The new rules come with a catch. The EpiPen cap has a loophole for high-deductible plans: it only kicks in after a patient has met their yearly deductible. And while consumers get a break, some in the insurance industry warn that mandating more coverage will just lead to higher premiums for everyone down the line.

The new laws represent a direct state-level intervention to curb specific, burdensome healthcare costs, setting up a classic tension between immediate patient affordability and the potential for broader increases in insurance premiums.