Colorado passed a law in 2023 that caps EpiPen co-pays at $60 for most people. Some families say they have difficulty obtaining medicines legally.
Colorado’s EpiPen cost cap has proven more difficult to implement than the state’s insulin cost limit, with some families struggling to find a pharmacy willing to sell the device for the required $60. There is.
One of the law’s main sponsors, as well as some pharmacies, have accused insulin manufacturers of refusing to comply with the law.
House Bill 1002The law, which took effect in January, caps out-of-pocket costs for epinephrine auto-injectors at $60 for a two-pack for most people through copay caps and separate affordability programs.
Epinephrine, also known as adrenaline, prevents your blood pressure from plummeting to dangerous levels and your airways from swelling and blocking during allergic reactions. People with severe allergies to certain foods or bee stings should carry epinephrine in case of accidental exposure.
Colorado’s out-of-pocket caps only apply to state-regulated health insurance plans, and so far that part seems to be going relatively well. Since the cap went into effect in January, the state Department of Insurance has received just four complaints, and in three of those cases, the complainants had insurance that is not regulated by the state, said spokesman Vince. Primell said. The police department is also continuing to investigate the fourth incident.
The rollout of this affordability program, aimed at people without regulated insurance or plans outside of Colorado, is similar to the program Colorado introduced in 2022 that caps insulin copays at $50 per month. Despite being very similar, it was even more difficult.
In theory, epinephrine users who can prove they are Colorado residents would only need to: Fill out the application form, pay $60 at a pharmacy that carries an EpiPen and take the medication with you. Epinephrine manufacturers must either fully refund pharmacies for the auto-injectors or send replacement stock.
However, some families said the program was quite difficult to use.
Rosie Haggard of Arvada said she ended up paying $110 out of pocket to buy auto-injectors for each of her two children. Her insurance is not regulated by the state, so the cap doesn’t apply. She said she tried taking advantage of affordability programs at several chain pharmacies, but she gave up.
“CVS said there was no plan in place, Walgreens said they didn’t have to comply…and King Soopers said they had no clue about the law,” she said.
Representatives from Walgreens, CVS and King Soopers all directed questions to the Colorado Retail Council. President Chris Howes said the group is ready to work with lawmakers on legislation to fix the rollout.
“There is a lack of proper guidance, education, and notification from state agencies and, frankly, weak regulatory oversight of manufacturer program compliance to ensure pharmacies are reimbursed by EpiPen manufacturers.” he said.
Ryan Laird, of Denver, also tried to use the program for several weeks to buy an auto-injector for his wife’s allergies, but gave up. Their insurance included Walgreens as an in-network pharmacy, but they hit a wall there, so they considered transferring her prescriptions to her CVS. He said he had trouble with CVS, which offered prices of more than $300.
“I contacted four or five different Walgreens companies and they all gave me the same response: They didn’t provide any guidance and they didn’t have a (billing) code,” he said. ” he said.
Not using epinephrine wasn’t an option, Laird said, so they ultimately decided to cut other budgets so they could buy an auto-injector and get reimbursed later. However, he is still dissatisfied with the process.
“The whole point of this law is that families don’t have to do this,” he says.
Manufacturers say they comply with the law
Tom Gierwatoski, president of RxPlus Pharmacys, a cooperative that allows independent pharmacies to benefit from price reductions through group purchasing, said pharmacies currently have no financially viable way to comply. He said no. The manufacturer does not reimburse the cost of dispensing the auto-injector, meaning the pharmacy only receives the $60 the patient paid.
“How can we dispense drugs for hundreds of dollars less?” he said.
Viatris, which makes the EpiPen, did not directly respond to The Denver Post’s questions about reimbursement, but issued a statement saying it is in compliance and has provided all necessary information to the Colorado State Board of Pharmacy.The company offers discount programs up to $300 off EpiPen copay., however, it is only available to those who have commercial insurance.provided by another program $25 off co-pay For common versions of the same group.
Companies have a financial incentive to ensure that insured patients do not stop filling prescriptions because of copays. If you do that, your insurance reimbursement will dry up. (Depending on the patient’s deductible and other medical costs, insurance may cover a large portion of the cost of a year’s worth of medications.) If the patient does not have insurance, the pharmacy counter may be able to help patients with their pain. Companies do not gain any benefit from mitigation. Because no one else will receive the rest of the bill.
Under Colorado’s Epinephrine Affordability Act, manufacturers can be fined up to $10,000 a month if they don’t reimburse pharmacies for epinephrine. It could also qualify non-compliance as deceptive trade practices and allow the Colorado Attorney General’s Office to get involved.
Congress could increase penalties
Sen. Dylan Roberts, D-Avon, one of the lead sponsors of the EpiPen affordability bill, said Congress may need to toughen the penalties. In some cases, pharmacies may simply not be aware of the change in the law, but if they truly cannot get reimbursed, another bill would be needed to bring drug companies into line, he said.
“It’s very unfortunate that these big drug companies are not complying with state law,” he said.
Roberts said he didn’t hear similar concerns when the Insulin Affordability Act, which he also sponsored, took effect two years ago.
“To their credit, insulin manufacturers were able to comply with the law,” he said.
Independent pharmacies did not have the same issues with insulin affordability programs, likely because: Manufacturer reduced price Gierwatski said the state implemented it not long after. He said he supports the intent of the epinephrine law, but questions whether states have the resources to force drug companies to comply.
“It needs to be enforced at the federal level, not the state level,” he said.
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