BILL NUMBER: S1804

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the insurance law, in relation to requiring coverage of
asthma inhalers at no cost

 
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 subsection (i) of section 3216 of the insurance law to
require that every insurance policy include coverage for inhalers for
the treatment of asthma. The section also requires that coverage would
not be subject to a deductible, copayment, coinsurance, or any other
cost-sharing requirement.

Section 2 amends subsection (I) of section 3221 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 health
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, more than 20 million
adults and over 4.5 million children were living with asthma in 2022.
Despite this reality, nothing has been done 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 to access this life-saving medication.
Typically, patients experience these costs through plan deductibles,
copayments, or coinsurance charges generally referred to as cost shar-
ing. 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, be hospitalized, and 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 every day
and is the sixth-leading cause of death in the United States.  Asthma
and COPD also place a strain on our healthcare system. Per the CDC, each
year, asthma is responsible for more than 1.7 million emergency depart-
ment 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 life-saving
medications connected to chronic diseases such as asthma highlights a
failing of our current system. We are charging those with illnesses more
money to access life-saving services and medications that no reasonable
person could call unnecessary. This bill will directly address the issue
by eliminating cost-sharing for these medications similar to the elimi-
nation 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:

2024: S9906 Rivera / A10692 Gonzalez-Rojas

 
FISCAL IMPLICATIONS:

Undetermined

 
EFFECTIVE DATE:
This act shall take effect immediately.