What's happening
This bill limits cost-sharing for participants in New York's elderly pharmaceutical insurance program to no more than 5% of their gross income.
Why it matters
Caps Out-of-Pocket Costs. By tying the maximum a participant can pay for drug coverage (including both annual fees and co-pays) to 5% of their gross income, the bill directly limits the financial burden on seniors, ensuring costs remain proportional to their means.
Protects Low-Income Seniors. This change is especially significant for those on fixed or limited incomes, who may otherwise face high out-of-pocket drug costs. It aims to prevent situations where seniors have to choose between medication and other essentials.
May Increase Access and Adherence. By lowering the risk of unaffordable costs, the bill could lead to higher rates of medication adherence among elderly New Yorkers, possibly improving health outcomes and reducing costs from untreated conditions.
Forces Program Adjustments. The program will need to track income and out-of-pocket spending more closely, potentially increasing administrative workload but also ensuring stronger consumer protections.
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Who cares
Eligible EPIC participants
The bill would cap their combined annual registration fee and co-payments at five percent of gross income during a coverage period.
Elderly Pharmaceutical Insurance Coverage program administrators
They would need to ensure participants’ combined fees and co-payments do not exceed the proposed income-based limit.
Advocates for older adults
The bill would limit eligible participants’ out-of-pocket costs under the prescription coverage program.
Headline styles
Cap Drug Costs for Seniors
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to aging
- Referred to aging
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3912
2019-2020 Regular Sessions
IN SENATE
February 21, 2019
Introduced by Sen. STAVISKY -- read twice and ordered printed, and when printed to be committed to the Committee on Aging
AN ACT to amend the elder law, in relation to limiting the cost-sharing responsibilities of eligible participants in the elderly pharmaceutical insurance coverage program
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 247 of the elder law is amended by adding a new subdivision 5 to read as follows:
5. Cost-sharing responsibilities limit. At no time during a coverage period shall the cost-sharing responsibilities, which are comprised of the sum of the annual registration fee and co-payments, exceed five percent of the eligible program participant's gross income, effective immediately.
§ 2. This act shall take effect on the one hundred twentieth day next succeeding the date on which it shall have become a law.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10057-01-9
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the elder law, in relation to limiting the cost-sharing responsibilities of eligible participants in the elderly pharmaceutical insurance coverage program
Purpose of the bill
Caps the out-of-pocket expenses (COPE) of an individual participant in either the Fee Plan or the Deductible Plan of the Elderly Pharmaceutical Insurance Coverage Program (EPIC) at five percent (5%) of annual gross income.
Summary of provisions
Section 247 of the elder law is amended to add new subdivision 5 to read:
3. Cost-sharing responsibilities limit. At no time during a coverage period shall the cost-sharing responsibilities, which are comprised of the sum of the annual registration fee and co-payments, exceed five percent of the eligible program participant's gross income, effective immediately.
Justification
The cost of prescription drugs for senior citizens is a well-documented issue that looms over the political landscape in New York and throughout the country. As drug prices continue to rise, there is an ever-increas- ing burden on senior incomes. Federal Medicare HMO's continue to dump seniors.
In New York, the Elderly Pharmaceutical Insurance Coverage (EPIC) Plan has picked up some of the burden. EPIC requires that participants pay a variety of premiums, fees, co-pays and deductibles. This currently rang- es from 4 to 7 percent of their incomes. COPE ensures that no one will pay more than 5 percent of their income. COPE will pick up the cost, pointing to a renewed urgency for Congress to resolve the issue in order to offset the State's commitment.
Fiscal implications
To be determined.
Legislative history
2016: S 3179 - referred to Aging
Effective date
This act shall take effect on the 120th day next succeeding the date on which it shall have become a law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.