Section 1. Short title
This Act may be cited as the Epinephrine’s Pharma Inflated Price Ends Now Act or the EPIPEN Act.
(a) PHSA
Part D of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–111 et seq.) is amended by adding at the end the following new section:
(a) In general
A group health plan, and a health insurance issuer offering group or individual health insurance coverage, shall provide coverage of epinephrine delivery systems, and with respect to such delivery systems, may not—
(1) apply any deductible; or
(2) impose any cost sharing in excess of $60 per package of 2 delivery systems (or the equivalent).
(b) Application of cost sharing toward deductibles and out-of-Pocket maximums
Any cost-sharing payments made pursuant to subsection (a)(2) shall be counted toward any deductible or out-of-pocket maximum that applies under the plan or coverage.
(c) Out-of-Network providers
Nothing in this section requires a plan or issuer that has a network of providers to provide benefits for an epinephrine delivery system described in this section that is delivered by an out-of-network provider, or precludes a plan or issuer that has a network of providers from imposing higher cost sharing than the levels specified in subsection (a)(2) for an epinephrine delivery system described in this section that is delivered by an out-of-network provider.
(d) Epinephrine delivery system defined
In this section, the term epinephrine delivery system means a delivery system approved by the Food and Drug Administration for the administration of epinephrine, including any auto-injector, nasal spray, or sublingual delivery system that is so approved.
(1) In general
Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following new section:
(a) In general
A group health plan, and a health insurance issuer offering group health insurance coverage, shall provide coverage of epinephrine delivery systems, and with respect to such delivery systems, may not—
(1) apply any deductible; or
(2) impose any cost sharing in excess of $60 per package of 2 delivery systems (or the equivalent).
(b) Application of cost sharing toward deductibles and out-of-Pocket maximums
Any cost-sharing payments made pursuant to subsection (a)(2) shall be counted toward any deductible or out-of-pocket maximum that applies under the plan or coverage.
(c) Out-of-Network providers
Nothing in this section requires a plan or issuer that has a network of providers to provide benefits for an epinephrine delivery system described in this section that is delivered by an out-of-network provider, or precludes a plan or issuer that has a network of providers from imposing higher cost sharing than the levels specified in subsection (a)(2) for an epinephrine delivery system described in this section that is delivered by an out-of-network provider.
(d) Epinephrine delivery system defined
In this section, the term epinephrine delivery system means a delivery system approved by the Food and Drug Administration for the administration of epinephrine, including any auto-injector, nasal spray, or sublingual delivery system that is so approved.
(2) Clerical amendment
The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.) is amended by inserting after the item relating to section 725 the following:
(1) In general
Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section:
(a) In general
A group health plan shall provide coverage of epinephrine delivery systems, and with respect to such delivery systems, may not—
(1) apply any deductible; or
(2) impose any cost sharing in excess of $60 per package of 2 delivery systems (or the equivalent).
(b) Application of cost sharing toward deductibles and out-of-Pocket maximums
Any cost-sharing payments made pursuant to subsection (a)(2) shall be counted toward any deductible or out-of-pocket maximum that applies under the plan.
(c) Out-of-Network providers
Nothing in this section requires a plan that has a network of providers to provide benefits for an epinephrine delivery system described in this section that is delivered by an out-of-network provider, or precludes a plan that has a network of providers from imposing higher cost sharing than the levels specified in subsection (a)(2) for an epinephrine delivery system described in this section that is delivered by an out-of-network provider.
(d) Epinephrine delivery system defined
In this section, the term epinephrine delivery system means a delivery system approved by the Food and Drug Administration for the administration of epinephrine, including any auto-injector, nasal spray, or sublingual delivery system that is so approved.
(2) Clerical amendment
The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item:
(d) Effective date
The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2026.