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Should the cost of EpiPens be capped? Some state lawmakers say yes

EPIPEN
Posted at 11:10 AM, Feb 02, 2023

COLORADO — Colorado lawmakers are looking to cap the cost of EpiPens, which can be a life-saving medication for people with severe allergies. A bill is set to go before a legislative committee on Friday this week.

The cost of the drug has risen by hundreds of dollars since 2007 when the price of the drug was about 95 dollars. for a pack of two. Today, a pack of two for EpiPens costs between $600-$700, and the generic version is about $400-$500.

State lawmakers are proposing a cap for a pack of two at $60.

"Deciding whether or not to access this life-saving medication can mean the difference of making rent or not," Representative Javier Mabrey, one of the bill's prime sponsors said.

Thousands of Coloradans living with allergies use the drug. According to the bill, more than 500,000 Coloradans have severe allergies, and of those more than 101,000 are under 18 years old.

With the drug increasing in price, many have turned to resources like a coupon provided by the drugmaker to reduce the cost. Others have been able to get the complete cost of the drug covered by insurance, but that's not the case for everyone.

Ann Bernard discovered her daughter Eden was deathly allergic to tree nuts when her daughter was only 17 months old. She had known her daughter was allergic to peanuts, but doctors recommended allergy testing to wait until her daughter was two years old. Years later, she remembers the discovery vividly.

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Ann Bernard makes a salad with her daughter Eden, who is deathly allergic to tree nuts.

"It was terrifying," Bernard recalled, "[she was] clawing at her neck, suffocating, her face was twice the size, bright red, she’s crying, doesn’t know what’s going on."

She remembers yelling at her son to get an EpiPen and she lodged it into her daughter's thigh and counted to 10.

"Every number I was getting more dramatic and more dramatic and more dramatic and crying cause I felt so bad," Bernard said.

Bernard's daughter is now in middle school and not only lives with her allergies, but a brain tumor. The older she gets, the more difficult it can be to avoid being around peanuts and tree nuts.

With the high cost of the drug, Bernard said she waits until she's met her $3,000 prescription drug deductible every year to get EpiPens.

"I’ve learned over the years to save expired ones and just hope if we ever need them that they’ll work," Bernard said.

The drug typically expires after one year and it is one-time use.

"We’re at the mercy of the EpiPen and they know that," Bernard said.

Lawmakers are proposing the cost of copays for EpiPens for people with insurance also be capped at $60. The bill is similar to a program passed by lawmakers in 2019 to cap the cost of insulin.

The insulin bill passed with bipartisan support. So far, no Republicans have signed on as sponsors. Mabrey said that will change after the bill is in committee.

This bill will also include a program set up by the Division of Insurance to provide the drug at the $60 price for people without health insurance. People who qualify will have to apply through the Division of Insurance.

The bill is facing opposition from insurance companies.

"The health insurance community is generally against the EpiPen cap bill,” Brandon Arnold with the Colorado Association of Health Plans said, "The industry would rather be able to work with their partners like the Division of Insurance, Department of Healthcare, Policy, and Finance to find solutions that aren’t going to create great impacts of Coloradans."

Arnold argues capping the cost doesn't get to the root of the problem, which is the manufacturers setting the high price. He added the cost would be passed on to higher health insurance premiums.

“That’s not affecting the actual price of the drug, it’s just shifting the cost from at the counter to then being wrapped up into premiums later on down the road,”’ Arnold said.

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