Effective January 1, 2024, the bill creates an epinephrine auto-injector affordability program (program) to provide low-cost epinephrine auto-injectors to individuals who:
- Are residents of this state;
- Are not enrolled in the state medicaid program or the federal medicare program;
- Have a prescription for an epinephrine auto-injector; and
- Are not enrolled in prescription drug coverage that limits the total amount of cost sharing that the enrollee is required to pay for an epinephrine auto-injector.
The bill requires the division of insurance in the department of regulatory agencies (division) to create an application for the program and requires the division and the department of health care policy and financing to make the application available on their websites and to promote the availability of the program.
The bill requires a carrier that provides coverage for prescription epinephrine auto-injectors to cap the total amount that a covered person is required to pay for all covered prescription epinephrine auto-injectors at an amount not to exceed $60 for a 2-pack of epinephrine auto-injectors.
A pharmacy that dispenses epinephrine auto-injectors is authorized to collect a copayment not to exceed $60 from the individual to cover the pharmacy's costs of processing and dispensing a 2-pack of epinephrine auto-injectors.
A manufacturer of epinephrine auto-injectors:
- Is required to make epinephrine auto-injectors available to individuals through the program; and
- May be required to reimburse the dispensing pharmacy an amount that covers the difference between the pharmacy's wholesale acquisition cost for the number of epinephrine auto-injectors dispensed through the program and the amount the recipients of the epinephrine auto-injectors paid for the same number of epinephrine auto-injectors or send the pharmacy a replacement supply of the same number of epinephrine auto-injectors.
If a manufacturer fails to comply with the requirements of the bill, the manufacturer may be subject to a fine.
(Note: This summary applies to this bill as introduced.)