New Yorkers will see new protections in their health coverage aimed at lowering out-of-pocket costs for critical care starting Jan. 1, 2026.
State law now requires insurers to cover medically necessary EpiPens, expand breast cancer screening and imaging coverage and provide insurance for scalp cooling systems used during chemotherapy.
“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.
EpiPen Coverage and Cost Caps
EpiPens, which treat life-threatening allergic reactions, have long been a financial burden for patients. Prices have soared over the past decade, with a pack of two pens now reaching around $600, up from about $60 when the medication was first acquired by Mylan in 2007. The short shelf life of these devices, roughly 12 months, means many patients must replace them annually and doctors recommend carrying two pens in case a single dose isn’t enough.
Under the new law, insurers in both the individual and group markets, including non-profit providers and HMOs, must cover medically necessary EpiPens for emergency treatment of allergic reactions. Out-of-pocket costs for these devices will be capped at $100 per year.
Breast Cancer Screening Expands
Breast cancer remains one of the most common cancers among New York women, with more than 17,000 diagnoses and nearly 2,400 deaths annually. One in eight women is expected to develop the disease in her lifetime and it is the second leading cause of cancer-related death in the state, particularly affecting women over 50.
The updated law ensures individual, group, and non-profit health plans cover breast cancer screening and diagnostic imaging, including mammograms, ultrasounds and MRIs, when recommended by a physician following recognized clinical guidelines. Cost-sharing will not apply except in cases affecting eligibility for health savings accounts.
Scalp Cooling Coverage for Chemotherapy Patients
Scalp cooling systems, which help reduce hair loss during chemotherapy, will now be covered for patients in the large group insurance market. Without insurance, a round of chemotherapy with scalp cooling can cost $1,500 to $3,000. The U.S. Food and Drug Administration has approved three different cooling systems, which work by reducing the amount of chemotherapy that reaches hair follicles, helping patients maintain hair and a sense of normalcy during treatment.
This measure marks the first law of its kind in the nation, reflecting growing recognition that cancer care must address more than just medical treatment. Lawmakers and advocates emphasized that coverage for scalp cooling helps preserve dignity and reduces stress for patients navigating chemotherapy.
