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Illinois Mandates Insurance Coverage of EpiPens for Children, Teens

November 5, 2019

Illinois is the first state to mandate insurance coverage of epinephrine injectors, more commonly known as EpiPens, for children.

House Bill 3435, which Gov. J B. Pritzker signed into law in August, goes into effect on January 1, 2020. All health insurance companies doing business in Illinois will have to cover "medically necessary epinephrine injectors for persons 18 years of age or under."

Rising Popularity

The Michigan legislature is considering a similar bill, and the measures have been popular with the public says Roger Klein, a physician, attorney, and policy advisor on drug pricing and precision medicine at The Heartland Institute, which publishes Health Care News, says the Epipen mandate is “a political gesture with uncertain substantive benefits.”

The real problem is the price of EpiPens, not insurance coverage, a problem H.B. 3425 does not address, Klein says.

“Injectable epinephrine, a potentially lifesaving medication for people experiencing severe allergic reactions, has been in the news for several years because of concerns about rising prices,” Klein said. “In addition, there have been shortages of some brands of this medicine. However, this law does not deal with cost issues, many of which have been addressed by increased competition. It mandates insurance coverage for epinephrine although it is not clear that coverage is a problem and most insurers appear to pay for it.”

Even the reported cost problems may be exaggerated, Klein says. 

“In fact, through prescription services like GoodRx the price is about what it cost in 2009 when manufacturer Mylan bought the rights to the EpiPen and began raising the price,” Klein said. “It is possible shortages of some brands could result in insurance denials if insurers do not cover alternative brands and that this could be dealt with through regulations issued under the law. However, I have not seen reports of this problem, and it is even possible that it is less expensive for some people to pay out-of-pocket than to use their insurance to pay for epinephrine injections.”

Unintended Consequences

The new mandate might cause further problems, Klein says.

“It is possible premiums will go up if the law ends up increasing the insurance companies’ costs, perhaps through the imposition of regulations that at a minimum create an administrative burden,” Klein said. “However, because it is unclear what, if any effect, the law actually has, it is difficult to estimate potential excess costs. It could end up doing and costing little.”

There is much more to the issue of EpiPen availability and affordability than the Illinois governor’s office has disclosed, Klein said.

“The governor mentioned the new law in a 140-character tweet, and the media jumped on it, providing headlines and positive publicity for Illinois politicians, but very little analysis or explanation of what the impact of the law is likely to be,” Klein said.

“During the 30 years EpiPen has been on the market, why haven’t other states passed similar laws?” Klein said. “The lesson is to be skeptical, and not to uncritically accept everything one reads, even from established media sources. Today’s news cycles appear to allow limited time for analysis and even essential factchecking.”

The Illinois Governor’s Office did not respond to a request for comment on this article.

 

Ashley Herzog (aebristow85@gmail.comwrites from Avon Lake, Ohio.

Author
Ashley Herzog writes from Avon Lake, Ohio.
aebristow85@gmail.com