BILL NUMBER: S9906

SPONSOR: RIVERA
 
PURPOSE OR GENERAL IDEA OF BILL:

To allow patients to access asthma inhalers without being subjected to
cost sharing.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends Section 3216 subsection (i) of the insurance law to
require that every insurance policy shall include coverage for i nhalers
for the treatment of asthma. The section also requires that coverage
shall not be subject to a deductible, copayment, coinsur ance or any
other cost-sharing requirement.

Section 2 amends Section 3221 subsection (1) of the insurance law to
require that every health insurance policy require coverage for inhalers
for the treatment of asthma and that coverage 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 heal th
service corporation to include coverage for inhalers for the treatment
of asthma coverage shall not be subject to a deductible, co payment,
coinsurance 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 wi th asth-
ma. This reality has done nothing to reduce the cost of asthma inhalers
as the price of each life-saving device can be as high as $640 a month
in some instances. Even with health insurance, individuals are subjected
to significant expenses in order to access this life saving medication.
Typically, patients experience these costs through plan deductibles,
copayments or coinsurance charges generally referred to as cost sharing.
The results are predictable and devastating.  Without consistent access
to inhalers, people with asthma and chronic obstructive pulmonary
disease (COPD) are more likely to get sick, to be hospitalized, and to
die.

The U.S Centers for Disease Control (CDC) has found that asthma kills
about 10 people every day, while COPD kills about 390 people ev ery day
and is the sixth-leading cause of death in the United States.  Asthma
and COPD also place a strain on our healthcare system. P er the CDC,
each year, asthma is responsible for more than 1.7 million emergency
department visits and over $50 billion in healthcare costs. According to
the New York State Department of Health, in New York alone more than 1.4
million adults have asthma. The issue is prevalent among children as
well. The US Centers for Disease Control (CDC) found that in 2021, New
York State had an estimated 315, 000 children with asthma, which was
about 8.9% of children in the state.

The concept of cost sharing was developed to reduce the unnecessary use
of medical services and supplies. To apply cost sharing to li fe saving
medications connected to chronic diseases such as asthma highlights a
failing of our current system. We are charging those with illnesses more
money in order to access life saving services and medications that no
reasonable person could call unnecessary. T his bill will directly
address the issue by eliminating cost sharing for these medications
similar to elimination of cost sharing for insulin, which was signed
into law in 2024. This bill is an important step forward to redressing
the failings of how our current healthcare system is designed.

 
PRIOR LEGISLATIVE HISTORY:

New Bill.

 
FISCAL IMPLICATIONS:

Undetermined

 
EFFECTIVE DATE:
This act shall take effect immediately.