The EPIPEN Act would require group health plans and group and individual health insurance coverage to cover FDA-approved epinephrine delivery systems. Plans could not apply a deductible or charge more than $60 for a package of two systems, or the equivalent. These payments would count toward deductibles and out-of-pocket limits. The rules would not require coverage from out-of-network providers and would allow higher charges for out-of-network systems. The changes would apply to plan years beginning on or after January 1, 2026.
If your plan is covered by the bill, you would not pay a deductible for an eligible epinephrine delivery system, and your cost sharing would be limited to $60 per package of two systems when using an in-network provider. The bill includes approved auto-injectors, nasal sprays, and sublingual systems. Different rules could apply to out-of-network providers.
The bill does not provide estimates of its overall costs or effects on insurance premiums. It sets a maximum cost-sharing amount of $60 per package of two delivery systems for covered in-network use.
No publicly available information.
No publicly available information.