Millions of diabetes patients in New York State are set to receive good news next year! A new law prohibiting medical insurance companies from charging patients copayments for insulin will come into effect on January 1, 2025, making New York the first state in the U.S. to ban insulin copayments.
Governor Hochu announced on November 25 on X platform that starting from January 1 next year, New York State will officially become the first state in the U.S. to ban insulin copayments. She stated that no one should suffer because they cannot afford life-saving medications. This new law will save millions of diabetes patients in the state money.
The amendment to Chapter 58 of the Insurance Law, which prohibits insulin copayments, was attached to the 2025 fiscal year budget earlier this year (from April of this year to March of next year). The new law stipulates that any medical insurance policies or contracts issued, renewed, amended, or modified on or after January 1 next year must cover diabetes treatment equipment and supplies, including prescription insulin. It also prohibits charging insured patients copayments, coinsurance, or any other fees for insulin. Patients will not have to bear the cost of administering prescription insulin at clinics or other outpatient facilities.
However, outpatient fees or other related service fees are not covered by this ban.
The medical insurance policies or contracts governed by this law include individual or group health insurance, comprehensive health insurance, and Federal Health Insurance (Medicare, red and blue cards); however, the Child Health Plus, Medicaid (white card), and Essential Plan are subject to other legal regulations, and medical insurance purchased through retirement plans under the Employee Retirement Income Security Act (ERISA) is not covered by the new law.
Currently, Chapter 56 of the Insurance Law in New York State limits the monthly copayment for prescribed insulin for insured patients to $100. Existing policies will continue to apply this regulation until January 1 next year, allowing them to charge copayments or coinsurance to patients for insulin. After January 1, they must comply with the regulations outlined in Chapter 58 and cannot charge patients for insulin.
The American Diabetes Association (ADA) points out that over the past decade, medical expenses for diabetes patients in the U.S. have increased by 35%, and diabetes patients’ medical costs are about 2.6 times higher than those without diabetes. Approximately 1.83 million adults in New York State have diabetes, accounting for 11.7% of the state’s adult population, with an estimated additional 92,000 diabetes patients each year. ADA and other nonprofit organizations are advocating for reduced patient copayments for insulin in 25 states and the District of Columbia, with New York being the first state to prohibit copayments.