EPIPEN Act Epinephrine’s Pharma Inflated Price Ends Now Act
Impact
The implications of HB6965 are significant as it seeks to make life-saving epinephrine injectors more accessible and affordable for individuals suffering from severe allergies. By limiting the out-of-pocket costs associated with these injectors, the bill aims to reduce financial barriers that patients may face when trying to secure necessary medications. Additionally, this legislation includes measures to ensure that any copayment incurred is applied toward the overall deductible and out-of-pocket maximum of the health plan, thereby enhancing the financial protections offered to consumers.
Summary
House Bill 6965, titled the 'Epinephrine’s Pharma Inflated Price Ends Now Act' or the 'EPIPEN Act', aims to amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986. This bill mandates that group health plans and health insurance issuers provide coverage for epinephrine injectors with specific cost-sharing parameters. Specifically, it prohibits any deductibles from being applied to these injectors and caps cost sharing at $60 per package of two injectors, effective for plan years beginning after January 1, 2025.
Contention
While the HB6965 has generally been met with supportive rhetoric from advocates focusing on health accessibility, there are notable points of contention surrounding the implications of the bill on insurers and health plans. Critics argue that the provisions could lead to increased premiums or adjustments in how plans operate to account for the mandated coverage and cost-sharing requirements. Furthermore, there are concerns regarding the treatment of out-of-network providers; the bill does not compel coverage for epinephrine injectors received from such providers, possibly limiting consumer choices in emergency situations.