BILL NUMBER:  S2489A

 TITLE OF BILL :

An act to amend the education law, in relation to the substitution of
brand name epinephrine auto-injectors with alternate epinephrine
auto-injectors for dispensation by pharmacists

 PURPOSE :

To ensure affordable access to epinephrine.

 SUMMARY OF PROVISIONS :

Section one adds a new subdivision (3) to Education Law § 6816-a to
authorize a pharmacists to substitute an alternate epinephrine
auto-injector when a brand-named epinephrine auto-injector has been
prescribed, provided the prescriber has not prohibited such
substitution, and that the epinephrine auto-injector will cost the
consumer less, and that the consumer has consented to receive the
alternative product.

Section two provides that the act take effect immediately.

 JUSTIFICATION :

              

The unconscionable price increases of EpiPens by Mylan Pharmaceutical
have made life saving epinephrine unaffordable for many families.
Mylan has continuously raised the price of EpiPens, with last year's
increase of 75% bringing the cost to over $600. In 2016 Mylan
announced they will authorize a generic version of the EpiPen for
$300, which is still more than three times the price of the EpiPen
when they acquired the product in 2007.

The exorbitant rates that Mylan is charging hits all consumers. For
those in need of the lifesaving medication, even if they have
insurance coverage, depending on their deductible, they may have to
pay the entire cost out-of-pocket, many others encounter much larger
co-pays. Families need to have multiple EpiPens so they are available
at home, school, daycare, when traveling. Insurance many not cover
multiple packages. Given EpiPens expire annually, this becomes a
yearly family cost. Given EpiPens are not a luxury, as a necessity
families are forced to figure out a way to bare these costs. Even
consumers who do not need epinephrine get hit with this cost through
increased insurance premiums and taxpayers dollars spent on EpiPens by
EMTs and though the state Medicaid program.

There are cheaper epinephrine auto-injector alternatives to EpiPens.
For example, Impax Laboratories makes a generic Adrenaclick which can
be purchased at for as low as $140 if you use a free coupon found on
GoodRx. Both products, EpiPens and Adrenaclick, are auto-injector
syringes filled with epinephrine. The difference in the products is in
the injector itself Adrenaclick has two caps, while EpiPen has one.
Due to this difference in injector technology, the products are
technically two different drugs and a pharmacists cannot substitute
one for another. CVS has also recently announced they will offer a
generic EpiPen for a fraction of the price.

While New York generic substitution law requires pharmacists to
dispense a lower cost generic for a brand prescription unless the
prescriber writes "dispense as written," since there is technically no
generic version of the EpiPen, the pharmacist could not substitute
generic Adrenaclick if the prescriber issued a prescription
specifically for an EpiPen. However, if the prescriber were to issue
the prescription for an epinephrine auto-injector, the pharmacist
could dispense the less expensive generic version.
Since Mylan has poured billions of dollars into making EpiPen a
household name, it has almost become synonymous with epinephrine
auto-injector. As a result, most prescribers issue prescriptions
specifically for EpiPens. They aren't aware of a reason to write
epinephrine auto-injector instead, and families aren't aware to ask
for such. This legislation, which will allow a pharmacist to dispense
an alternate epinephrine auto-injector under a brand-name
prescription, is necessary to remedy this.

Under this legislation, a family can request and a pharmacist can
dispense the less expensive version without having to request a new
prescription from the prescriber. New York would be joining more than
a dozen states that allow for this substitution. We cannot let such a
technicality come between New Yorkers and affordable access to this
life saving medication.

 LEGISLATIVE HISTORY :

2016: S.8189

 FISCAL IMPLICATIONS :

None.

 EFFECTIVE DATE :
Immediately.