Bill > HR5139

This bill, known as the "EPIPEN Act," aims to regulate cost sharing for epinephrine delivery systems across group health plans and individual health insurance coverage. The legislation mandates that health insurance providers must cover epinephrine delivery systems (such as auto-injectors, nasal sprays, and sublingual systems approved by the FDA) without applying any deductibles and limiting cost sharing to no more than $60 per package of two delivery systems. Any cost-sharing payments made will count towards the plan's deductible and out-of-pocket maximum. The bill specifies that while providers with networks are not required to cover out-of-network epinephrine delivery systems, they must provide coverage for FDA-approved systems within their network. The changes will apply to plan years beginning on or after January 1, 2026, and the bill amends three key pieces of legislation: the Public Health Service Act, the Employee Retirement Income Security Act, and the Internal Revenue Code. The primary goal is to make epinephrine delivery systems more affordable and accessible for individuals who require these critical medical devices, particularly those with severe allergies who may need emergency epinephrine administration.

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https://www.congress.gov/bill/119th-congress/house-bill/5139/all-info