New law will require no-cost EpiPen coverage

STATE HOUSE – A new law sponsored by Sen. Pamela J. Lauria and Rep. Michelle McGaw will require health insurers in Rhode Island to cover the full cost of life-saving epinephrine injectors, commonly known by the brand name EpiPen.

The legislation (2023-S 0575A, 2023-H 5176A), which was approved by the General Assembly June 16 and signed by Gov. Dan McKee June 22,  is aimed at preventing costs from being an obstacle to those whose lives depend on the device, which is used to manage severe symptoms of an anaphylactic reaction such as throat swelling or difficulty breathing.

“Epinephrine is an absolute necessity for anyone with a serious allergy that could result in anaphylaxis, including many children. The skyrocketing costs of these devices is an outrage and needs to be addressed, but in the meantime, it must not be allowed to discourage or prevent people from filling their prescription. Having epinephrine available quite literally makes the difference between life and death for a person experiencing anaphylaxis, so costs should not stand in the way for anyone,” said Representative McGaw (D-Dist. 71, Portsmouth, Tiverton, Little Compton), who works as a consultant pharmacist serving the long-term care community.

The new law will require private and nonprofit insurers and HMOs that provide prescription coverage to cover at least one twin pack per year of at least one type of epinephrine auto-injector and cartridges, without copayments or deductibles, for all policies issued or renewed after Jan. 1, 2025.

Said Senator Lauria (D-Dist. 32, Barrington, Bristol, East Providence), who is a nurse practitioner, “As a matter of public health and safety, it’s irresponsible to allow the high costs of epinephrine to be passed on to patients, because it means so many people are going without, at tremendous risk to themselves or their children. We are very grateful to our colleagues and leadership in the General Assembly for recognizing the importance of passing this legislation this year.”

Mylan, the manufacturer of the brand-name Epi-Pen, raised its price by about 500 percent between 2009 and 2016, resulting in average prices of more than $600 per twin pack today. Even patients with prescription coverage may be saddled with high cost-sharing rates for the drug. In recent years, generic versions of the device have been developed, but they still cost $300 or more per twin pack.

The single-use injectors expire 18 months from when they are manufactured, so patients need to purchase new ones frequently regardless of whether they are ever used. Patients also need to have one available at all times, so they may need to keep several at once. Many of those at risk for anaphylaxis are children, who may be exposed to their allergen at school or through other children.