New Jersey caps out-of-pocket inhaler, epinephrine autoinjector costs

Key takeaways:

• Epinephrine autoinjector costs will be capped at $25 and asthma inhaler costs will be capped at $50.
• These monthly caps will apply to all state-regulated and public employee health insurance plans.

Gov. Phil Murphy of New Jersey has signed legislation that will cap monthly out-of-pocket prescription costs for epinephrine autoinjectors at $25 and asthma inhalers at $50 in all state-regulated and public employee health insurance plans.

S-1614 also extends Medicare’s cap on monthly insulin costs at $35 to these plans. New Jersey joins Minnesota as the only two states in the nation to place caps on the costs of epinephrine injectors such as EpiPen (Pfizer) as well as on inhalers and insulin.

Last month, Colorado passed a law capping the cost of a two-pack of epinephrine autoinjectors at $60, whereas Rhode Island passed a law requiring health insurers to cover the full costs of these devices.

“This is a huge step forward in our ongoing efforts to deliver much needed relief to countless families throughout our state who are struggling to afford critical medications,” Murphy said in a press release.

“I am proud to sign nation-leading legislation that will make a real difference in the lives of New Jerseyans as we continue to work towards making prescription drugs and other health care services more affordable and accessible to everyone,” Murphy continued.

Murphy also signed S-1615, which creates a data and transparency system in the state’s Division of Consumer Affairs to collect, analyze and report on the drug pricing process, and A-536/2841, which establishes greater oversight of pharmacy benefit managers.

“Many individuals and families across New Jersey rely on insulin, EpiPens and asthma inhalers for daily maintenance and emergency access. National data shows that people of color experience higher rates on average of health conditions such as diabetes and asthma,” Christi Peace, deputy press secretary, Office of New Jersey Gov. Murphy, told Healio.

“Additionally, working- and middle-class New Jersey residents are more likely to experience challenges affording their medications. As such, many of these residents may particularly benefit from the caps implemented through this new law,” Peace said.

Impact on families

“Access to safe, effective and affordable medicines is critical as the rising costs of prescription drug prices puts Americans at risk for poorer health outcomes and deepens inequities for many living with chronic and life-threatening conditions such as asthma and severe allergies,” Charmayne Anderson, MPA, director of advocacy, Allergy & Asthma Network, told Healio.

Charmayne Anderson

“People living with asthma and/or severe allergies have watched the cost of asthma inhalers and epinephrine auto-injectors rise exponentially through the years. Making them more affordable helps ensure these potentially lifesaving medications are more readily available,” Anderson continued.

The New Jersey Department of Health reports that more than 600,000 adults and 167,000 children in the state have asthma, with greater odds for asthma among Black individuals, Hispanic individuals and urban residents as well as among individuals with a family history of the disease.

Food allergies are prevalent in New Jersey as well, according to Food Allergy Resource & Education (FARE).

“On behalf of the more than 930,000 New Jerseyans with potentially life-threatening food allergies, FARE applauds the state legislature and Gov. Murphy for capping the cost of epinephrine autoinjectors and ensuring that all residents can afford the only medicine that can save their lives,” Sung Poblete, RN, PhD, CEO of FARE, told Healio.

According to Jason Linde, MA, senior vice president of advocacy at FARE, an epinephrine autoinjector typically includes a dollar’s worth of medicine and costs $8 to manufacture, which makes the high cost to purchase these devices particularly frustrating.

“The price of lifesaving epinephrine has skyrocketed over the past decade, with many families now paying upwards of $700 for one two-pack of epinephrine autoinjectors,” Linde told Healio.

Jason Linde

Noting that autoinjectors have a 1-year expiration date and that children need autoinjectors for both home and school, Linde said that at $1,400, annual costs for epinephrine total more than the $1,367 average monthly mortgage in New Jersey.

“Because of the tremendous cost of epinephrine autoinjectors, these caps help all families,” Linde said, “but especially historically underserved communities, the working poor and the middle class as all face a horrific economic choice — purchase the lifesaving medicine they or someone else in their families need or go without food and basic necessities.”

Anderson agreed that caps on medication costs not only would help everyone but also eliminate cost barriers preventing many low-income families from getting the medications they need, as these skyrocketing costs are a kitchen-table issue for many families.

“When faced with high out-of-pocket costs, asthma and allergy patients may not use their medications appropriately by either skipping doses in order to save money or abandoning treatment altogether,” Anderson said. “Stabilized treatments are necessary for patients with chronic conditions, and access to medications is critical.”

Linde also said that FARE strongly supports price caps on epinephrine autoinjectors and appreciates states such as New Jersey that are leading the way to ensure they are both affordable and accessible.

“It is unlikely that a federal epinephrine price-cap bill could be passed into law, and we support the states taking the lead to solve this problem,” Linde said.

Anderson expressed a need for similar nationwide legislation as well, as patients who forgo medical care may develop poor health and lead to increases in health care spending.

“For patients with chronic conditions like asthma, it is essential that they have the medications they need to effectively manage their disease, and for those living with severe allergies, the first-line treatment for anaphylaxis (ie, life-threatening allergic reaction) is epinephrine,” Anderson said. “Patients should not have to choose between life or death when determining if they can afford the medication that will save their lives.”

Also, Linde said that FARE is grateful for the work that allergists and ED physicians perform in diagnosing food allergies and treating anaphylaxis.

“They are not the reason that epinephrine autoinjectors are outrageously expensive,” Linde said. “If they would like to help, in addition to providing outstanding care, we would welcome and applaud state medical associations in lobbying for and supporting epinephrine price caps in their own states.”

In the meanwhile, Anderson said, doctors should talk about these costs directly with their patients, who often do not think to bring up prescription costs during their appointments, leaving them unaddressed.

“Doctors should be prepared to discuss out-of-pocket expenses as a factor in a patient’s overall care plan. They can suggest generic inhalers and epinephrine autoinjectors that are in most cases less expensive,” Anderson said.

“They may be able to pass on product samples or drug discounts,” Anderson continued. “Doctors can also suggest telemedicine and asthma coaching programs that are less costly than routine office visits.”

References:

• EpiPen outrage: It costs about $8 to make a two-pack, engineers say. https://www.mercurynews.com/2016/10/01/epipen-outrage-silicon-valley-engineers-figure-true-cost-to-make-lifesaving-auto-injector-about-10/. Published Oct. 1, 2016. Accessed July 11, 2023.
• EpiPens cost just several dollars to make. Customers pay more than $600 for them. https://www.cnbc.com/2016/08/25/epipens-cost-just-several-dollars-to-make-customers-pay-more-than-600-dollars-for-them.html. Published Aug. 25, 2016. Accessed July 11, 2023.
• HB23-1002 Epinephrine auto-injectors. https://leg.colorado.gov/bills/hb23-1002. Published June 7, 2023. Accessed July 11, 2023.
• New Jersey mortgage calculator: Estimate your monthly payment. https://www.moneygeek.com/mortgage/new-jersey/calculator/. Published Feb. 23, 2023. Accessed July 11, 2023.
• New R.I. law will require no-cost coverage for epinephrine injectors. https://pbn.com/new-r-i-law-will-require-no-cost-coverage-for-epinephrine-injectors/#:~:text=STATEHOUSE%20%E2%80%93%20A%20new%20law%20will,16%20and%20signed%20by%20Gov. Published July 2, 2023. Accessed July 11, 2023.
• State of New Jersey Department of Health Chronic Disease Programs. https://www.nj.gov/health/fhs/chronic/asthma/in-nj/. Accessed July 11, 2023.