Every session of the state Legislature brings a fresh crop of proposals that would drive up health-care costs, and 2025 is no exception.

Here is a sampling of pending bills that, if enacted, would further drive up New Yorkers’ health insurance premiums, which are already among the highest in the U.S.:

Unleashing ‘340B’

S. 1913 (Gustavo Rivera) and A. 6222 (Amy Paulin)

This bill would empower hospitals and clinics to increase their profits from the 340B program, a 1992 federal law requiring pharmaceutical manufacturers to provide special discounts on drugs sold to certain providers.

Originally targeted to safety-net institutions serving the poor, the program has grown to involve two out of three New York hospitals and some 1,500 pharmacies across the state. The rules of the program do not require that the discounts be passed along to customers, enabling providers to charge a markup and use the money however they like.

In effect, 340B has become a general subsidy for eligible providers with little relation to need and minimal oversight. There’s evidence that the program has led to overutilization of high-priced drugs and driven up the cost of cancer treatment. There have been widespread calls for reform.

Drug manufacturers have tried to contain the growth of the program by imposing auditing requirements and other limits on participating providers. River and Paulin’s bill would prohibit these practices, which it describes as discrimination.

Because 340B purchases are not eligible for manufacturer rebates that offset drug costs, expanding the program is likely to lead to higher pharmaceutical expenses for insurers and increased premiums for employers and consumers.

Limiting cost-sharing for inhalers

S. 1804 (Gustavo Rivera) and A. 128 (Jessica Gonzàlez-Rojas)

This bill mandates that state-regulated insurers provide each asthma patient with at least one rescue inhaler and one maintenance inhaler with no cost-sharing.

This would ease a potential burden on some families, but only by shifting the expense to other insurance customers – including those who would still face full cost-sharing for other medications and devices that are equally important.

Also, this rule would not apply to the majority of employers that are self-insured, and thereby exempt from most state regulations by federal law.

This is one of dozens of insurance mandates introduced by the Legislature each year without a formal analysis of costs and benefits, as is required in 29 other states.

The New York Health Plan found that more than 40 of these measures have become law over the years, including requirements that state-regulated insurers cover in vitro fertilization, chiropractic care and donated human breast milk.

“While the cost of individual mandates may be small, collectively they increase health insurance premiums and make coverage more expensive for employers and consumers,” the association warns.

Imposing a $10 fee on prescriptions

S. 5939 (James Skoufis) and A. 5882 (John McDonald)

This proposal would set a minimum price that pharmacies would be entitled to collect from pharmacy benefit managers, including a dispensing fee of $10.18 for each prescription filled.

The sponsors argue that a few large pharmacy benefit managers exercise too much control over the prescription drug market and use their leverage to underpay pharmacists.

However, setting a minimum state-imposed price is likely to further drive up pharmaceutical costs for insurers, employers and patients. The $10.18 fee by itself, if applied to millions of prescriptions filled each year, would add billions to the state’s health-care expenditures.

The bill closely matches a proposal floated in 2023 as a proposed regulation the state Department of Financial Services. The department dropped that plan in the face of opposition from labor unions, public and private employers, and the health insurance industry.

Although the number of pharmacies has shrunk nationwide in recent years, New York’s industry remains relatively robust. As of 2023, it had the second-highest number of pharmacies per capita of any state. And the number of independent pharmacies, defined as having no more than three locations, had risen by 324 or 14 percent over the previous decade.