New York Governor Kathy Hochul signed legislation yesterday requiring health insurers to cover epinephrine auto-injector devices (commonly known as EpiPens) and capping the out-of-pocket cost to consumers at $100. The bill, sponsored by State Senator Gustavo Rivera, had breezed through the legislature, passing in the Senate unanimously and receiving just two dissenting votes in the State Assembly. “When every second counts, the last thing New Yorkers should have to worry about is whether they can afford the medication they need to survive an anaphylactic reaction,” Hochul said. “By signing this bill, we are putting people over profit and giving New Yorkers peace of mind by ensuring equitable access to this lifesaving emergency treatment.”
This bill is the latest move from New York’s political leadership to address high health care costs. Last year, New York Attorney General Letitia James secured an agreement with insulin manufacturer Novo Nordisk to cap the cost of insulin for uninsured New Yorkers at $35 per month for the next five years in the state, while Governor Hochul passed another measure as part of the state’s 2025 budget eliminating insulin cost-sharing for any New Yorkers on a state-regulated health care plan.
In both cases, New York’s elected officials find themselves fighting against the monopoly power of drug manufacturers, as the rising costs of EpiPens and insulin are not explained by market forces. Reports have found a tenfold increase in insulin prices between 1999 and 2019, an extreme surge that has no basis in inflation or the cost to manufacture the lifesaving hormone, which was first synthesized more than a hundred years ago. (The doctors who discovered insulin sold its patent for $1 in order to avoid this exact situation.) A 2021 report from The Intercept revealed how an executive from Mylan pharmaceuticals (Heather Bresch, daughter of West Virginia Senator Joe Manchin) colluded with the CEO of pharmaceutical giant Pfizer to corner the market and keep EpiPen prices artificially high.
The fact that both insulin and EpiPens are lifesaving treatments for those who need them allows the few large companies that produce them to pressure consumers on price. “The manufacturers of insulin know that patients who need it will spend whatever it takes to acquire it, regardless of price,” says Dr. S. Vincent Rajkumar in a commentary piece for the Mayo Clinic. “It is a matter of life and death.” Researchers estimated in 2023 that about 16% of diabetics skip insulin doses due to its high cost. Documents obtained by The Intercept shed light on this aspect of Mylan’s strategy as well with EpiPens, as its own market research led to the conclusion that “since it was a matter of life and death, customers would suck it up” if Mylan jacked up the price.
Mylan settled for $264 million in a price gouging lawsuit in 2022, after hiking the price of EpiPens from $100 to $600 over ten years. The cost to manufacture an EpiPen is around one dollar.
