The bill mandates that group health plans and health insurance coverage must provide coverage for epinephrine delivery systems without applying any deductibles and limit cost-sharing to a maximum of $60 for a package of two delivery systems. Additionally, any payments made toward cost-sharing must count toward the plan's deductible and out-of-pocket maximums, ensuring that these costs do not disproportionately affect consumers' healthcare finances.
Summary
House Bill 5139, known as the 'Epinephrine’s Pharma Inflated Price Ends Now Act' or the 'EPIPEN Act', is designed to amend several federal statutes, including the Public Health Service Act, Employee Retirement Income Security Act, and Internal Revenue Code. Its primary focus is on establishing requirements related to cost-sharing for epinephrine delivery systems, aiming to make these life-saving devices more affordable and accessible for individuals with severe allergies.
Contention
Opposition to HB5139 may arise due to concerns over how these coverage requirements could affect healthcare costs and insurance premiums. Critics may argue that while the bill promotes necessary access to epinephrine delivery systems, it may unintentionally lead to higher premiums for consumers as insurers adjust their pricing to compensate for mandated coverage. Furthermore, the stipulation that out-of-network providers can impose higher cost-sharing could raise concerns regarding equitable access and the actual affordability of these systems in practical scenarios.
Defines epinephrine device as a single-use device or nasal spray device used for the automatic injection or administration of a premeasured dose of epinephrine into the human body for the purpose of emergency treatment of a person appearing to experience anaphylactic symptoms.
Health: pharmaceuticals; administration of epinephrine; modify. Amends title & secs. 1, 2 & 3 of 2020 PA 312 (MCL 28.821 et seq.). TIE BAR WITH: HB 5054'25, HB 5049'25, HB 5050'25, HB 5052'25, HB 5053'25