Requires health insurance plans to provide coverage for epi-pens for individuals 18 years old and younger

2025 Regular Session Introduced by James Sanders

Requires health plans to cover epinephrine auto-injectors for people 18 and under, reducing out-of-pocket costs and speeding access for children with severe allergies.

REFERRED TO INSURANCE

Summary: Bill S 6295

What the bill would do

The bill, titled “Requires health insurance plans to provide coverage for epi-pens for individuals 18 years old and younger,” would mandate that health insurance plans cover epinephrine auto-injectors (commonly known as Epipen) for individuals 18 and under.

Status and process

Introduced: March 10, 2025

Current status: REFERRED TO INSURANCE (in committee)

Legislative actions to date: Referred to Insurance on 2025-03-10 (listed twice in the actions)

Sponsor: James Sanders Jr. (primary)

Purpose and intent

The core aim is to improve access to life-saving treatment for children and adolescents with severe allergies by ensuring their auto-injector devices are covered by health plans. By removing or reducing cost barriers, the bill intends to promote timely access to epinephrine in emergency situations.

Key provisions (as currently described)

Requires health insurance plans to provide coverage for epi-pens (epinephrine auto-injectors) for individuals 18 years old and younger.

Specifics such as cost-sharing (copays/deductibles), formulary placement, prior authorization, eligibility criteria, renewal requirements, and any exemptions are not included in the provided information. The actual bill text would detail these elements if present.

Who is affected

Beneficiaries: Children and young adults up to age 18 who require epinephrine auto-injectors.

Families and guardians: Potentially reduced out-of-pocket costs and simpler access to prescribed devices.

Health insurers and plans: Would be required to provide this coverage, potentially impacting plan design and pricing.

Healthcare providers and pharmacies: May experience changes in prescribing and dispensing processes to align with the new coverage requirement.

Related and prior context

Related bills from prior sessions: S 5983 and S 6634, indicating ongoing legislative interest in securing epi-pen coverage.

This bill is part of the broader policy question of expanding mandated benefits and access to essential medications.

Practical considerations and next steps

As the bill is in the Insurance committee, it will likely undergo hearings, possible amendments, and votes before moving to the full chamber.

Potential fiscal impact, implementation details, and any carve-outs would be clarified in the bill’s full text and any committee amendments.

If you’d like, I can compare with the related bills (S 5983 and S 6634) or draft a brief note on potential fiscal implications once the text becomes available.