NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A128A
SPONSOR: Gonzalez-Rojas TITLE OF BILL:
An act to amend the insurance law, in relation to requiring coverage of
certain asthma inhalers at no cost
PURPOSE OR GENERAL IDEA OF BILL:
Requires insurance coverage for inhalers at no cost
SUMMARY OF PROVISIONS:
Section 1 amends Section 3216 subsection (i) of the insurance law to
require that every insurance policy shall include coverage for inhalers
for the treatment of asthma. The section also requires that coverage for
one form of rescue inhaler and one form of maintenance inhaler shall not
be subject to a deductible, copayment, coinsurance or any other cost-
sharing requirement.
Section 2 amends Section 3221 subsection (1) of the insurance law to
require that ever health insurance policy require coverage for inhalers
for the treatment of asthma and that coverage for one form of rescue
inhaler and one form of maintenance inhaler shall not be subject to a
deductible, copayment, coinsurance or any other cost-sharing require-
ment.
Section 3 amends Section 4303 of the insurance law to add a new
subsection to require a medical expense indemnity corporation or health
service corporation to include coverage for inhalers for the treatment
of asthma coverage for one form of rescue inhaler and one form of main-
tenance inhaler shall not be subject to a deductible, copayment, coinsu-
rance or any other cost-sharing requirement.
Section 4 sets the effective date.
JUSTIFICATION:
According to the U.S Food and Drug Administration in 2022 more than 20
million adults and over 4.5 million children were living with asthma.
But this reality has done nothing to reduce the cost of asthma inhalers
with the price of each life-saving device being as high as $640 a month
in some instances. U.S Senator Bernie Sanders wrote to manufacturers
stating that the prices force patients, especially the uninsured and
underinsured, to ration doses or abandon their prescriptions altogether.
The results are predictable and devastating. Without consistent access
to inhalers, people with asthma and COPD are more likely to get sick, to
be hospitalized, and to die.
The U.S Centers for Disease Control has found that asthma kills about 10
people every day, while chronic obstructive pulmonary disease (COPD)
kills about 390 people every day and is the sixth-leading cause of death
in the United States. Asthma and COPD also place a strain on our health-
care system. Per the CDC, each year, asthma is responsible for more than
1.7 million emergency department visits and over $50 billion in health-
care costs.
Recently, manufacturers AstraZeneca, Boebringer Ingelheim, and GlaxoS-
mithKline committed to capping the out-of-pocket cost at $35 a month.
This bill will require no cost for inhalers in New York State so we can
treat asthma and save lives.
LEGISLATIVE HISTORY:
2024: Introduced and reported to Insurance Committee
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
To be determined.
EFFECTIVE DATE:
This act shall take effect on January 1, 2027 and shall apply to all
policies and contracts issued, renewed, modified, altered, or amended on
or after such date.
STATE OF NEW YORK
________________________________________________________________________
128--A
2025-2026 Regular Sessions
IN ASSEMBLY(Prefiled)
January 8, 2025
___________
Introduced by M. of A. GONZALEZ-ROJAS, PAULIN, SAYEGH, EPSTEIN, HEVESI,
SHRESTHA, SIMON, JACKSON, ZACCARO, LUNSFORD, DAVILA, DE LOS SANTOS,
MAMDANI, RAGA, SHIMSKY, LASHER, TORRES, SIMONE, SOLAGES, LEVENBERG,
BICHOTTE HERMELYN, STECK, CLARK, ROZIC, KAY, P. CARROLL, CUNNINGHAM,
GALLAGHER, DINOWITZ, BURROUGHS, DAIS, REYES, HOOKS, FORREST, RAMOS,
KASSAY -- read once and referred to the Committee on Insurance --
committee discharged, bill amended, ordered reprinted as amended and
recommitted to said committee
AN ACT to amend the insurance law, in relation to requiring coverage of
certain asthma inhalers at no cost
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subsection (i) of section 3216 of the insurance law is
2 amended by adding a new paragraph 41 to read as follows:
3 (41) (A) Every policy which provides medical, major medical or similar
4 comprehensive-type coverage and provides coverage for prescription drugs
5 shall include coverage for inhalers for the treatment of asthma if
6 prescribed by a physician or other licensed health care provider legally
7 authorized to prescribe under title eight of the education law.
8 (B) Coverage shall be provided for one form of rescue and one form of
9 maintenance inhaler that shall not be subject to a deductible, copay-
10 ment, coinsurance or any other cost-sharing requirement.
11 (C) If the policy is a high deductible health plan as defined in
12 section 223(c)(2) of the Internal Revenue Code of 1986, such coverage
13 may be subject to the plan's annual deductible if application of this
14 requirement would result in ineligibility for a health savings account.
15 § 2. Subsection (l) of section 3221 of the insurance law is amended by
16 adding a new paragraph 23 to read as follows:
17 (23) (A) Every group or blanket accident and health insurance policy
18 issued or issued for delivery in this state which provides medical,
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD00983-04-5
A. 128--A 2
1 major medical or similar comprehensive-type coverage and provides cover-
2 age for prescription drugs shall include coverage for inhalers for the
3 treatment of asthma if prescribed by a physician or other licensed
4 health care provider legally authorized to prescribe under title eight
5 of the education law.
6 (B) Coverage shall be provided for one form of rescue and one form of
7 maintenance inhaler that shall not be subject to a deductible, copay-
8 ment, coinsurance or any other cost-sharing requirement.
9 (C) If the policy is a high deductible health plan as defined in
10 section 223(c)(2) of the Internal Revenue Code of 1986, such coverage
11 may be subject to the plan's annual deductible if application of this
12 requirement would result in ineligibility for a health savings account.
13 § 3. Section 4303 of the insurance law is amended by adding a new
14 subsection (ww) to read as follows:
15 (ww) (1) A medical expense indemnity corporation or a health service
16 corporation which provides medical, major medical or similar comprehen-
17 sive-type coverage and provides coverage for prescription drugs shall
18 include coverage for inhalers for the treatment of asthma if prescribed
19 by a physician or other licensed health care provider legally authorized
20 to prescribe under title eight of the education law.
21 (2) Coverage shall be provided for one form of rescue and one form of
22 maintenance inhaler that shall not be subject to a deductible, copay-
23 ment, coinsurance or any other cost-sharing requirement.
24 (3) If the policy is a high deductible health plan as defined in
25 section 223(c)(2) of the Internal Revenue Code of 1986, such coverage
26 may be subject to the plan's annual deductible if application of this
27 requirement would result in ineligibility for a health savings account.
28 § 4. This act shall take effect January 1, 2027 and shall apply to all
29 policies and contracts issued, renewed, modified, altered, or amended on
30 or after such date.
