This year, the state of Illinois made history as the first state to require insurance companies to offer EpiPen coverage for all resident children. House Bill 3435 took effect on January 1, 2020 and effectively shifts the burden of paying for the live-saving injections from parents to insurance companies. The law requires all insurance companies offering health insurance coverage in the state to pay for all epinephrine injectors for any individual 18 or younger suffering from the potential of a severe allergic reaction.
This legislation could not come at a better time, as the cost of EpiPens has risen significantly in recent years. Mylan, the company that produces EpiPens, acquired the manufacturing rights for the drug in 2007. In just over 10 years, Mylan increased the price of the product by more than 400 percent. From 2007 to 2015, the price of a two-pack auto-injector went from $50.00 to over $600.00 per dosage. The increase resulted in enormous profits for Mylan and its CEOS, a fact which national lawmakers found important when deciding to approve the production of a generic drug. Epinephrine, the drug held within the pen, is already a generic drug, but the device aspect of the EpiPen was patented and difficult for other pharmaceutical companies to replicate. Prior to the legislation passed in September of 2016, Mylan was the only company able to produce the “drug-device” combination that facilitates the EpiPen injection.
The rising costs and single manufacturer contributed to the drug becoming largely unavailable for many children in need. In 2018, the nation was suffering from a widespread shortage of EpiPens and, due to their scarcity, many children were forced to go without the safety of carrying this lifesaving injection. Although the pharmaceutical company Teva was granted the right to produce a generic version of an EpiPen, these doses were not yet available for purchase. The shortage grew to such a level that the Food and Drug Administration extended the expiration dates for certain batches of EpiPens by four months in an attempt to alleviate the supply disruption. Parents were forced to live with the anxiety of not having the necessary medicine for their child.
The production of generic EpiPens has curbed the severity of the crisis somewhat, but many parents report that the drug is still not available on a regular, affordable basis. Illinois Governor JB Pritzker’s new legislation offers help to families in need. House Bill 3435 amended The State Employee Group Insurance Act to require the coverage of EpiPens by any insurance company offering coverage in the state of Illinois. The bill does not specify which drug patients may choose and requires insurance coverage of EpiPens or one of the five available alternatives. This will allow parents to choose the strain of the medicine that is most beneficial to their child’s individual needs. Further, the bill does not specify how this new requirement will affect co-pays, other out of pocket costs, or deductibles. Nonetheless, many see it as a bright future for those requiring the drug. By mandating coverage, Illinois makes its residents’ need for the drug more explicit, which will hopefully contribute to more availability in the state. Parents of children requiring the life saving injection can find comfort in the fact that insurance companies will now assist in the regular costs of the drug.
If you have questions, contact Sherer Law Offices at (618) 692-6656 for more information.
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