Section 1 Short title
This Act may be cited as the “Epinephrine’s Pharma Inflated Price Ends Now Act” or the “EPIPEN Act”.
Epinephrine’s Pharma Inflated Price Ends Now Act
A BILL
To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to establish requirements with respect to cost sharing for epinephrine injectors under group health plans and group and individual health insurance coverage.
Sec. 2 Requirements with respect to cost sharing for epinephrine injectors
PHSA— Part D of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–111 et seq.) is amended by adding at the end the following new section:
“2799A–11. Requirements with respect to cost sharing for epinephrine injectors
“(a) In general—A group health plan, and a health insurance issuer offering group or individual health insurance coverage, shall provide coverage of epinephrine injectors, and with respect to such injectors, may not—
“(1) apply any deductible; or
“(2) impose any cost sharing in excess of $60 per package of 2 injectors (or the equivalent).
“(b) Application of cost sharing toward deductibles and out-of-Pocket maximums—Any cost-sharing payments made pursuant to subsection (a)(2) shall be counted toward any deductible or out-of-pocket maximum that applies under the plan or coverage.
“(c) Out-of-network providers—Nothing in this section requires a plan or issuer that has a network of providers to provide benefits for an epinephrine injector described in this section that is delivered by an out-of-network provider, or precludes a plan or issuer that has a network of providers from imposing higher cost sharing than the levels specified in subsection (a)(2) for an epinephrine injector described in this section that is delivered by an out-of-network provider.
“(d) Epinephrine injector defined—In this section, the term epinephrine injector means an auto-injector approved by the Food and Drug Administration for the administration of epinephrine.”
ERISA—
In general— Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following new section:
“726. Requirements with respect to cost sharing for epinephrine injectors
“(a) In general—A group health plan, and a health insurance issuer offering group health insurance coverage, shall provide coverage of epinephrine injectors, and with respect to such injectors, may not—
“(1) apply any deductible; or
“(2) impose any cost sharing in excess of $60 per package of 2 injectors (or the equivalent).
“(b) Application of cost sharing toward deductibles and out-of-Pocket maximums—Any cost-sharing payments made pursuant to subsection (a)(2) shall be counted toward any deductible or out-of-pocket maximum that applies under the plan or coverage.
“(c) Out-of-Network providers—Nothing in this section requires a plan or issuer that has a network of providers to provide benefits for an epinephrine injector described in this section that is delivered by an out-of-network provider, or precludes a plan or issuer that has a network of providers from imposing higher cost sharing than the levels specified in subsection (a)(2) for an epinephrine injector described in this section that is delivered by an out-of-network provider.
“(d) Epinephrine injector defined—In this section, the term epinephrine injector means an auto-injector approved by the Food and Drug Administration for the administration of epinephrine.”
Clerical amendment— The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.) is amended by inserting after the item relating to section 725 the following:
IRC—
In general— Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section:
“9826. Requirements with respect to cost sharing for epinephrine injectors
“(a) In general—A group health plan shall provide coverage of epinephrine injectors, and with respect to such injectors, may not—
“(1) apply any deductible; or
“(2) impose any cost sharing in excess of $60 per package of 2 injectors (or the equivalent).
“(b) Application of cost sharing toward deductibles and out-of-Pocket maximums—Any cost-sharing payments made pursuant to subsection (a)(2) shall be counted toward any deductible or out-of-pocket maximum that applies under the plan.
“(c) Out-of-Network providers—Nothing in this section requires a plan that has a network of providers to provide benefits for an epinephrine injector described in this section that is delivered by an out-of-network provider, or precludes a plan that has a network of providers from imposing higher cost sharing than the levels specified in subsection (a)(2) for an epinephrine injector described in this section that is delivered by an out-of-network provider.
“(d) Epinephrine injector defined—In this section, the term epinephrine injector means an auto-injector approved by the Food and Drug Administration for the administration of epinephrine.”
Clerical amendment— The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item:
Effective date— The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2025.