Prohibits cost sharing for insulin; provides that an insured shall not be subject to a deductible, copayment, coinsurance or any other cost sharing requirement for the purchase of insulin.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A4141A
SPONSOR: Forrest TITLE OF BILL:
An act to amend the insurance law, in relation to prohibiting cost shar-
ing for insulin
PURPOSE:
To ban cost sharing for insulin prescriptions from the current $100 per
insulin per month.
SUMMARY OF PROVISIONS:
Sections 1 through 3 of the bill amend various sections of insurance law
which were amended as part DDD of Chapter 56 _of the laws of 2020, the
adopted budget, to change the $100 limit on cost sharing for insulin to
a prohibition on cost sharing for insulin.
Section 4 of the bill provides for an effective date.
JUSTIFICATION:
2.1 million New Yorkers have diabetes and 30% of type two diabetics are
insulin dependent. There are 20,000 hospitalizations in NY each year
with a principal diagnosis of diabetes related complications including
diabetic ketoacidosis.
Type 1 and some Type 2 diabetics depend upon insulin for their very
survival. In 2016 the average person with type 1 diabetes incurred annu-
al insulin costs of $5,705.00. While some pay less, many others pay many
times this amount. When patients can't afford insulins, which can cost
thousands of dollars even for those who are insured, they resort to
rationing the little medication they can afford. In fact, one study
found one in four people with type 1 diabetics admitted to not taking
their insulin as prescribed, or rationing, due to the cost.
Complications from rationing insulin are extreme leading to amputations,
Diabetic KETOACIDOSIS, also referred to as DKA, and even death.
As part of the adopted 2020-21 state budget a cap on cost sharing was
adopted (Part DDD, Chapter 56 of 2020). However, unlike the legislation
which passed the Senate in 2019 (S 6497A) capping the cost of all insu-
lins a person needs per month at $100, the budget language capped cost
sharing per prescription. Given many diabetics rely on two or three
different types of insulin they may still have cost sharing of $300 per
month. This legislation changes the $100 cap to a prohibition on cost-
sharing for each insulin per month.
A prohibition on insulin cost-sharing would be the first in the nation
and would set an example for other states to follow. It goes further but
is more in line with the caps other states are pursuing and adopting to
address access to affordable insulin than the current $100 capa. For
example, Utah recently adopted a $30 copay and states such as New Mexi-
co, Virginia, California, and Connecticut are all in various stages of
passing and adopting copays that range from $25 to $50 per insulin.
While New York's new law capping insulin is an important first step, we
must truly make access to insulin affordable and eliminate copays
entirely for this essential and life-saving medication.
LEGISLATIVE HISTORY:
2021-2022: A2383 (Niou) - held for consideration in insurance
2019-2020: A10821 (Niou) - referred to insurance
FISCAL IMPLICATIONS:
No cost to the state
EFFECTIVE DATE:
Immediately and shall apply to any policy or contract written or renewed
on or after January 1, 2024.
STATE OF NEW YORK
________________________________________________________________________
4141--A
2023-2024 Regular Sessions
IN ASSEMBLY
February 10, 2023
___________
Introduced by M. of A. FORREST, RAGA, GALLAGHER, SHRESTHA, GONZALEZ-RO-
JAS, ARDILA, ALVAREZ, DARLING, AUBRY, SIMON, COLTON, BURDICK, MAMDANI,
CHANDLER-WATERMAN, MITAYNES, MEEKS, STECK, KELLES, BLUMENCRANZ, DeSTE-
FANO, WALKER, SEPTIMO, TAPIA, TAYLOR, THIELE, ANDERSON, TAGUE,
BENDETT, HYNDMAN, DICKENS, DURSO, SIMONE, EPSTEIN, CRUZ, DAVILA, COOK,
SHIMSKY, LUNSFORD, BORES, CURRAN, LEVENBERG, FLOOD, MAHER, JACOBSON,
BURGOS, HUNTER, CUNNINGHAM, RAJKUMAR, CARROLL, SANTABARBARA, JACKSON,
CLARK, REYES -- read once and referred to the Committee on Insurance
-- recommitted to the Committee on Insurance in accordance with Assem-
bly Rule 3, sec. 2 -- committee discharged, bill amended, ordered
reprinted as amended and recommitted to said committee
AN ACT to amend the insurance law, in relation to prohibiting cost shar-
ing for insulin
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subparagraph (B) of paragraph 15-a of subsection (i) of
2 section 3216 of the insurance law, as amended by section 1 of part DDD
3 of chapter 56 of the laws of 2020, is amended to read as follows:
4 (B) Such coverage may be subject to annual deductibles and coinsurance
5 as may be deemed appropriate by the superintendent and as are consistent
6 with those established for other benefits within a given policy;
7 provided however, [the total amount] that [a covered person is required
8 to pay out of pocket for] covered prescription insulin drugs shall [be
9 capped at an amount not to exceed one hundred dollars per thirty-day
10 supply, regardless of the amount or type of insulin needed to fill such
11 covered person's prescription and regardless of the insured's] not be
12 subject to a deductible, copayment, coinsurance or any other cost shar-
13 ing requirement.
14 § 2. Subparagraph (B) of paragraph 7 of subsection (k) of section 3221
15 of the insurance law, as amended by section 2 of part DDD of chapter 56
16 of the laws of 2020, is amended to read as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD02649-03-4
A. 4141--A 2
1 (B) Such coverage may be subject to annual deductibles and coinsurance
2 as may be deemed appropriate by the superintendent and as are consistent
3 with those established for other benefits within a given policy;
4 provided however, [the total amount] that [a covered person is required
5 to pay out of pocket for] covered prescription insulin drugs shall [be
6 capped at an amount not to exceed one hundred dollars per thirty-day
7 supply, regardless of the amount or type of insulin needed to fill such
8 covered person's prescription and regardless of the insured's] not be
9 subject to a deductible, copayment, coinsurance or any other cost shar-
10 ing requirement.
11 § 3. Paragraph 2 of subsection (u) of section 4303 of the insurance
12 law, as amended by section 3 of part DDD of chapter 56 of the laws of
13 2020, is amended to read as follows:
14 (2) Such coverage may be subject to annual deductibles and coinsurance
15 as may be deemed appropriate by the superintendent and as are consistent
16 with those established for other benefits within a given policy;
17 provided however, [the total amount] that [a covered person is required
18 to pay out of pocket for] covered prescription insulin drugs shall [be
19 capped at an amount not to exceed one hundred dollars per thirty-day
20 supply, regardless of the amount or type of insulin needed to fill such
21 covered person's prescription and regardless of the insured's] not be
22 subject to a deductible, copayment, coinsurance or any other cost shar-
23 ing requirement.
24 § 4. This act shall take effect January 1, 2025 and shall apply to any
25 policy or contract issued, renewed, modified, altered, or amended on or
26 after such date.
