New York State implemented several new health insurance coverage requirements on January 1, expanding access to certain medications, cancer screenings, and treatment-related services.
Governor Kathy Hochul announced that under the new laws, health insurers will be required to cover medically necessary EpiPen devices with an annual out-of-pocket cap, expand coverage for breast cancer screening and diagnostic imaging, and provide coverage for scalp cooling systems used during chemotherapy.
State officials said the changes are intended to reduce financial barriers to care for patients who rely on these treatments and services.
EpiPen Coverage
Under the new law, health insurers in the individual and group markets, including nonprofit insurers and health maintenance organizations (HMOs), must cover medically necessary epinephrine auto-injectors, commonly known as EpiPens, for emergency treatment of severe allergic reactions. Out-of-pocket costs for covered EpiPen devices will be capped at $100 per year.
EpiPens are used to treat anaphylaxis, a potentially life-threatening allergic reaction that can be triggered by foods, insect stings, medications, or other exposures. The cost of the devices has increased significantly over the past decade, and they typically expire after about a year, requiring regular replacement.
Breast Cancer Screening and Imaging
The new law also expands insurance coverage for breast cancer screening and diagnostic imaging. Individual, group, and nonprofit health plans will be required to cover screening and diagnostic mammograms, breast ultrasounds, and breast MRIs when recommended by a physician in accordance with nationally recognized clinical guidelines.
The law specifies that cost-sharing will not apply to these services unless required to maintain eligibility for health savings accounts under federal rules.
Breast cancer remains one of the most commonly diagnosed cancers in New York State, with approximately 17,000 new cases and about 2,400 deaths reported statewide each year, according to state data.
Scalp Cooling Systems During Chemotherapy
The new law also requires health insurers in the large group market to cover scalp cooling systems used during chemotherapy treatment. Scalp cooling is a method used to reduce hair loss by lowering the temperature of the scalp before, during, and after chemotherapy sessions.
Scalp cooling systems are approved by the U.S. Food and Drug Administration and are currently covered by Medicare and Medicaid, but often require significant out-of-pocket payments from patients with private insurance.
State officials said the coverage changes are expected to reduce costs for patients undergoing cancer treatment and those managing severe allergies, beginning with insurance plans in effect on or after January 1, 2026.
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