S.7114.A/A.6425.A – Mandate Coverage of Epi-Pens and Caps Cost Sharing

This legislation, S.7114-A/A.6425-A, would require health insurance providers to cover epinephrine auto-injector devices and set a maximum copayment of $100 annually for two of these devices. New York’s health plans provide coverage for anaphylaxis treatments, including related equipment and supplies such as epi-pens. However, the New York Health Plan Association (HPA) opposes the legislation that places a cap on the cost sharing.

It is estimated that approximately 1.5 million Americans have an epinephrine prescription. The average cost of a prescription is $650-$700 per two pen pack, without insurance.[1] The price of epi-pens has increased significantly since 2007 when Mylan Pharmaceuticals received the rights to produce and sell the medication in the auto-injector device, jumping by 220% between 2007 and 2014. In the following decade, the price jumped again by more than $253 percent.

EpiPen

Used to treat severe allergic reactions

While well intentioned, limiting cost sharing does nothing to improve affordability by failing to address the major driver of skyrocketing health care costs: the increasing escalation and exorbitant prices drug manufacturers charge. It is the excessive cost of prescription medications – set and controlled solely by drug makers – that creates a barrier for patients to receive the treatments they need. This legislation will do nothing to make prescription drugs more affordable for consumers, but it will lead to higher premiums for consumers and employers.

Restricting or limiting cost-sharing levels increases monthly premiums and places an additional financial strain on small businesses and working families. Rather than limiting cost-sharing, the focus should be on measures to promote greater accountability into lowering pharmaceutical prices and making prescription medications more affordable for New Yorkers.

While we support the goals of ensuring access to necessary life-saving medications, the New York Health Plan Association (HPA) opposes capping the cost-sharing of epinephrine auto-injector devices.

Affordability of coverage continues to be a concern for many New Yorkers as health care costs in the state remain among the highest in the nation. Legislative proposals limiting cost-sharing agreements at set amounts exacerbates this challenge and does nothing to address the spiraling underlying costs of prescription drugs, which is a key driver heath care costs in New York.

For all the reasons stated above, we urge you to say no to S.7114-A/A.6425-A.

[1] GoodRx; https://www.goodrx.com/epinephrine-epipen/how-to-save-cost