BILL NUMBER: S3539

SPONSOR: RIVERA
 
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-in-
jector 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 epineph-
rine 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 Adre-
naclick 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 expen-
sive generic version.

Since Nylan has poured billions of dollars into making EpiPen a house-
hold name, it has almost become synonymous with epinephrine auto-injec-
tor. As a result, most prescribers issue prescriptions specifically for
EpiPens. They aren't aware of a reason to write epinephrine auto-injec-
tor instead, and families aren't aware to ask for such. This legis-
lation, which will allow a pharmacist to dispense an alternate epineph-
rine 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 (Hannon)
2017: S2489 (Hannon)

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
immediately.