NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A6425A
SPONSOR: O'Donnell 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 ("epi-
pens") and set an annual cost-sharing cap.
SUMMARY OF PROVISIONS:
Section 1 amends Insurance Law Section 3216, Subsection (i) by adding
paragraph 39, which:
(A) requires all New York insurance plans which issue accident and
health insurance policies to provide coverage for at-minimum two medi-
cally-necessary epinephrine auto-injector devices at an out-of-pocket
cost not exceeding $100 annually, AND
(B) specifies that "epinephrine auto-injector device" will have the same
definition as that which is stated in Public Health Law Section 3000-C,
Subdivision, paragraph (b).
Section 2 amends Insurance Law Section 3221, Subsection (k) by adding
paragraph 23, which:
(A) requires all New York insurance plans which issue group or blanket
accident or health insurance policies (which include coverage for physi-
cian services in a physician's office) to provide coverage for at-mini-
mum two medically-necessary epinephrine auto-injector devices at an
out-of-pocket cost not exceeding $100 annually. Further clarifies that
if, under 26 USC 223, application of this requirement would result in
health savings account (HSA) ineligibility, the requirement shall apply
to HSA-qualified high-deductible health plans only after the enrollee
has satisfied the minimum deductible outlined in USC 223(c)(2)(C), AND
(B) specifies that "epinephrine auto-injector device" will have the same
definition as that which is stated in Public Health Law Section 3000-C,
Subdivision, paragraph (b).
Section 3 amends Insurance Law Section 4303 by adding a subsection (vv),
which:
(A) requires all New York medical expense indemnity corporations, hospi-
tal service corporations, and health service corporations (which include
coverage for physician services in a physician's office) to provide
coverage for at-minimum two medically-necessary epinephrine auto-injec-
tor devices at an out-of-pocket cost not exceeding $100 annually.
Further clarifies that if, under 26 USC 223, application of this
requirement would result in health savings account (HSA) ineligibility,
the requirement shall apply to HSA-qualified high-deductible health
plans only after the enrollee has satisfied the minimum deductible
outlined ln USC 223(c)(2)(C), AND
(B) specifies that "epinephrine auto-injector device" will have the same
'definition as that which ts stated in Public Health Law Section 3000-C,
Subdivision, paragraph (b).
Section 4 provides the effective date.
JUSTIFICATION:
The rising cost of an epinephrine auto-injector device (commonly known
by the brand name "epi-pen") has far outpaced inflation in the last 15
years. Without mandated insurance coverage and a reasonable cost-sharing
cap, the accessibility of these life-saving devices is beyond the means
of millions of New Yorkers.
Separate studies by NIH and Blue Cross Blue Shield indicated a strong
correlation between skyrocketing epi-pen prices, and the number of emer-
gency room visits by children having serious anaphylactic reactions. An
epinephrine auto-injector significantly mitigates the risk of death from
a serious allergic reaction.
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. Far too many New
Yorkers are now forced to decide whether they will spend hundreds 'of
dollars per year on a device which they hope to never need to use.
Financial means should not be a barrier to life-saving medicine.
