Health Insurance & Medical Costs · Surprise rank #50
Have a NY-Regulated Health Plan? Covered Prescription Insulin Must Cost You $0
New York prohibits deductibles, copayments, coinsurance and other cost sharing for covered prescription insulin under qualifying New York-regulated health insurance policies.
Who
People enrolled in individual, small-group or large-group health insurance policies/contracts subject to the New York Insurance Law insulin rule.
Where: New York-regulated health insurance
What to do
Start here: Check whether the insurance ID card says 'fully insured coverage' or ask the insurer whether the plan is New York-regulated; challenge insulin cost sharing that conflicts with the rule.
Eligibility: The health coverage must be subject to the New York rule and the insulin must be covered and obtained in the circumstances described by the policy and DFS guidance.
What you get
Covered prescription insulin must be covered in full without cost sharing under qualifying New York-regulated policies.
Benefit: $0 cost sharing for covered prescription insulin.
Possible value: Depends on the insulin prescription and what the plan would otherwise charge.
Good to know
Important: The law does not apply to self-funded ERISA plans. Child Health Plus, Medicaid Managed Care and the Essential Plan follow separate cost-sharing rules. Out-of-network insulin and unrelated office-visit charges are not automatically made free by this rule.
Availability: Active for policies issued, renewed, modified, altered or amended on or after January 1, 2025
Why people miss it: Many people remember New York's older $100 insulin cap and do not realize qualifying prescription insulin moved to zero cost sharing.
Sources reviewed: Aug 10, 2026