NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A7853
SPONSOR: Cunningham
 
TITLE OF BILL:
An act to amend the public health law and the state finance law, in
relation to an emergency insulin program
 
PURPOSE OR GENERAL IDEA OF BILL:
To create an Emergency Insulin Program to ensure that those dependent on
insulin for their survival can access emergency supplies
 
SUMMARY OF PROVISIONS:
Section 1 establishes an Emergency Insulin Program. This program shall
ensure that recipients can access emergency supplies of analog insulins
and related supplies no later than April 1, 2024, assuming an appropri-
ation or sufficient funds. A recipient is a person diagnosed with type 1
diabetes, or type 2 insulin dependent diabetes and who is at risk of
experiencing serious adverse health effects due to a lack of analog
insulins, and who is uninsured or underinsured. Other definitions are
provided.
The program also allows providers to prescribe analog insulins under a
non-patient specific prescription. Any pharmacy with 20+ locations in
the state and any facility with a drug discount program shall pursue or
maintain a non-patient specific prescription to dispense analog insulins
and to register with the department as an emergency insulin program by
January 1, 2024.
The commissioner of health shall immediately begin to work with analog
insulin manufacturers to create a public-private partnership to support
the state's streamlined Emergency Insulin Program that may replicate
patient support programs such manufactures already have. The commis-
sioner may establish a sliding scale for cost sharing for certain recip-
ients which shall not exceed $100 for a 3C day supply of analog insulins
and related supplies. The commissioner shall publish findings on the
program and share them with the governor and legislature within 1 year
of the effective date and every 2 years thereafter.
Section 2 creates a special revenue fund in the joint custody of the
state comptroller and the commissioner of taxation and finance to be
known as the Emergency Insulin Program Trust Fund to support the Emer-
gency Insulin Program.
Section 3 provides for an immediate effective date.
 
DIFFERENCE BETWEEN ORIGINAL AND AMENDED VERSION (IF APPLICABLE):
N/A
 
JUSTIFICATION:
2.1 million New Yorkers have diabetes, and there are 20,000 hospitaliza-
tions in NY each year with a principal diagnosis of diabetes-related
complications. Type 1 and some type 2 diabetics depend upon insulin for
their very survival. In 2016, the average person with type 1 diabetes
incurred annual insulin costs of $ 5,705. When patients can't afford
insulin, which can cost thousands of dollars even for those who are
insured, they resort to rationing the little medication they can afford.
One study found that 1 in 4 people with type 1 diabetes admitted to not
taking their insulin as prescribed, or rationing, due to the cost.
Complications from rationing insulin can be extreme, such as diabetic
ketoacidosis (DKA), amputations, and even death.
This legislation creates an Emergency Insulin Program, modeled after New
York State's Opioid Prevention Program, which has made access to life-
saving naloxone to reverse an opioid overdose widely available in our
state. Under the Emergency Insulin Program, individuals who are unin-
sured or underinsured will 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 but it would be
capped at $100 for a 30 day supply of insulin and supplies.
The bill directs DOH to immediately engage analog insulin manufacturers
to support the state program and facilitate quick access to affordable
analog insulins in emergency situations. A public-private partnership
can streamline existing patient support programs such manufactures have.
The three manufactures of analog insulin each have programs designed to
help people access their products at a reduced rate or for free; howev-
er, each program is different and they can be difficult to access, espe-
cially in emergency situations. Recognizing that these manufacturers
want to make sure everyone can access life-saving medications, this bill
establishes an Emergency Insulin Program Trust Fund to accept funds for
the statewide program.
While it is true that some types of human insulin 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 diabetics require. These low-cost human insulins are less commonly
prescribed by doctors precisely because of their unpredictable rate of
absorption, which can result in more frequent low and high blood sugar.
They require more monitoring and more supplies and when people transi-
tion from the newer, more costly analog insulins the risk of dead in bed
syndrome is greatly increased.
New York must do all it can to make sure that diabetics who depend on
insulin for their survival can access emergency supplies of analog insu-
lin, just as we currently ensure that friends, families, and first
responders are equipped with life-saving naloxone in the case of an
overdose. 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. This Emergency Insulin Program
will ensure that those in need can access this life-saving medication.
 
PRIOR LEGISLATIVE HISTORY:
2021-22: A194 - Referred to Health
2019-20: A10054 - Referred to Health
 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
To be determined, but there are potential savings as expensive hospital-
izations as a result of severe adverse reactions from patients rationing
or running out of insulin are avoided.
 
EFFECTIVE DATE:
Immediately.
STATE OF NEW YORK
________________________________________________________________________
7853
2023-2024 Regular Sessions
IN ASSEMBLY
July 7, 2023
___________
Introduced by M. of A. CUNNINGHAM -- read once and referred to the
Committee on Health
AN ACT to amend the public health law and the state finance law, in
relation to an emergency insulin program
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The public health law is amended by adding a new article
2 28-CC to read as follows:
3 ARTICLE 28-CC
4 EMERGENCY INSULIN PROGRAM
5 Section 2894. Emergency insulin program.
6 § 2894. Emergency insulin program. 1. The commissioner is authorized
7 and directed to establish an emergency insulin program to ensure that
8 recipients of the program can access emergency supplies of analog insu-
9 lins and related supplies. The commissioner shall immediately engage
10 analog insulin manufacturers to support the state program and facilitate
11 quick access to affordable analog insulins in emergency situations. The
12 commissioner shall establish standards for approval of any emergency
13 insulin program, and analog insulin prescribing, dispensing, distrib-
14 ution, and possession pursuant to this section which may include, but
15 not be limited to, standards for program directors, appropriate clinical
16 oversight, training, record keeping and reporting. The emergency insulin
17 program shall, pursuant to an appropriation or sufficient funds in the
18 emergency insulin program trust fund, be available to recipients no
19 later than April first, two thousand twenty-four.
20 2. (a) As used in this section:
21 (i) "Analog insulins" means at a minimum short-acting, rapid-acting,
22 intermediate and long acting insulin drugs approved by the Food and Drug
23 Administration that, when administered, to certain recipients are life-
24 saving, and help avoid serious adverse effects associated with type one
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD05256-01-3
A. 7853 2
1 diabetes and in some limited cases type two diabetes, and other medica-
2 tions and supplies approved by the department for such purpose.
3 (ii) "Health care professional" means a person licensed, registered or
4 authorized pursuant to title eight of the education law to prescribe
5 prescription drugs.
6 (iii) "Pharmacist" means a person licensed or authorized to practice
7 pharmacy pursuant to article one hundred thirty-seven of the education
8 law.
9 (iv) "Recipient" means a person: (1) diagnosed with type one diabetes,
10 or type two insulin dependent diabetes; and (2) who is at risk of expe-
11 riencing serious adverse health effects due to a lack of analog insu-
12 lins; and (3) who is uninsured or underinsured; or (4) an organization
13 registered as an emergency insulin program pursuant to this section.
14 (b)(i) A health care professional may prescribe by a patient-specific
15 or non-patient-specific prescription, dispense or distribute, directly
16 or indirectly, analog insulins to a recipient.
17 (ii) A pharmacist may dispense analog insulins, through a patient-spe-
18 cific or non-patient-specific prescription pursuant to this paragraph,
19 to a recipient.
20 (iii) The provisions of this paragraph shall not be deemed to require
21 a prescription for any analog insulins that do not otherwise require a
22 prescription; nor shall it be deemed to limit the authority of a health
23 care professional to prescribe, dispense or distribute, or of a pharma-
24 cist to dispense, analog insulins under any other provision of law.
25 (iv) Any pharmacy with twenty or more locations in the state, and any
26 facility established pursuant to article twenty-eight of this chapter
27 which has a drug discount program authorized by section 340B of the
28 Federal Public Health Service act 42 U.S.C § 256b shall pursue or main-
29 tain a non-patient-specific prescription with an authorized health care
30 professional to dispense analog insulins to a recipient upon request, as
31 authorized by this section; and register with the department as an emer-
32 gency insulin program no later than January first, two thousand twenty-
33 four.
34 3. Use or dispensing of analog insulins pursuant to this section shall
35 be considered first aid or emergency treatment for the purpose of any
36 statute relating to liability.
37 4. The commissioner shall immediately begin to work with analog insu-
38 lin manufacturers in creating such program to ensure they are working
39 with the state in a public-private partnership to support the state's
40 streamlined emergency insulin program that may replicate patient support
41 programs such manufacturers have. A manufacturer may contribute to the
42 program through the emergency insulin program trust fund established
43 pursuant to section ninety-five-1 of the state finance law.
44 5. The commissioner may establish a sliding scale for cost sharing for
45 certain recipients which shall not exceed one hundred dollars for a
46 thirty-day supply of analog insulins and related supplies.
47 6. The commissioner shall publish findings on the emergency insulin
48 program including but not limited to the number of programs established,
49 the number of recipients served, the types and amounts of analog insu-
50 lins provided, the costs and savings associated with the program, and
51 what public-private partnerships the state has facilitated to support
52 this program to the governor and the chairs of the senate and assembly
53 health committees within one year of the effective date of this article
54 and every two years thereafter.
55 § 2. The state finance law is amended by adding a new section 95-1 to
56 read as follows:
A. 7853 3
1 § 95-1. Emergency insulin program trust fund. 1. There is hereby
2 established in the joint custody of the state comptroller and the
3 commissioner of taxation and finance a special fund to be known as the
4 "emergency insulin program trust fund".
5 2. Such fund shall consist of all monies appropriated for its purpose
6 and all monies received, or to be paid into or credited to such fund by
7 analog insulin manufacturers pursuant to subdivision four of section
8 twenty-eight hundred ninety-four of the public health law. Nothing
9 contained herein shall prevent the state from receiving assessments,
10 grants, gifts or bequests for the purposes of the fund as defined in
11 this section and depositing them into the fund according to law.
12 3. Monies of the fund shall be expended only to support the emergency
13 insulin program established pursuant to article twenty-eight-CC of the
14 public health law administered by the commissioner of health and for
15 funding emergency access to analog insulins.
16 4. Monies shall be payable from the fund on the audit and warrant of
17 the comptroller on vouchers approved and certified by the commissioner
18 of health.
19 § 3. This act shall take effect immediately.