119-hr5139

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5139 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 5139

 To amend title XXVII of the Public Health Service Act, the Employee 
 Retirement Income Security Act of 1974, and the Internal Revenue Code 
 of 1986 to establish requirements with respect to cost sharing for 
 epinephrine delivery systems under group health plans and group and 
 individual health insurance coverage.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 September 4, 2025

 Mr. Frost (for himself and Ms. Matsui) introduced the following bill; 
 which was referred to the Committee on Energy and Commerce, and in 
 addition to the Committees on Education and Workforce, and Ways and 
 Means, for a period to be subsequently determined by the Speaker, in 
 each case for consideration of such provisions as fall within the 
 jurisdiction of the committee concerned

_______________________________________________________________________

 A BILL

 To amend title XXVII of the Public Health Service Act, the Employee 
 Retirement Income Security Act of 1974, and the Internal Revenue Code 
 of 1986 to establish requirements with respect to cost sharing for 
 epinephrine delivery systems under group health plans and group and 
 individual health insurance coverage.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Epinephrine's Pharma Inflated Price 
Ends Now Act'' or the ``EPIPEN Act''.

SEC. 2. REQUIREMENTS WITH RESPECT TO COST SHARING FOR EPINEPHRINE 
 DELIVERY SYSTEMS.

    (a) PHSA.--Part D of title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg-111 et seq.) is amended by adding at the end the 
following new section:

``

SEC. 2799A-11. REQUIREMENTS WITH RESPECT TO COST SHARING FOR 
 EPINEPHRINE DELIVERY SYSTEMS.

 ``

    (a) In General.--A group health plan, and a health insurance 
issuer offering group or individual health insurance coverage, shall 
provide coverage of epinephrine delivery systems, and with respect to 
such delivery systems, may not--
 ``

    (1) apply any deductible; or
 ``

    (2) impose any cost sharing in excess of $60 per package 
 of 2 delivery systems (or the equivalent).
 ``

    (b) Application of Cost Sharing Toward Deductibles and Out-of-
Pocket Maximums.--Any cost-sharing payments made pursuant to subsection

    (a)

    (2) shall be counted toward any deductible or out-of-pocket maximum 
that applies under the plan or coverage.
 ``
            (c) Out-of-Network Providers.--Nothing in this section requires a 
plan or issuer that has a network of providers to provide benefits for 
an epinephrine delivery system described in this section that is 
delivered by an out-of-network provider, or precludes a plan or issuer 
that has a network of providers from imposing higher cost sharing than 
the levels specified in subsection

    (a)

    (2) for an epinephrine delivery 
system described in this section that is delivered by an out-of-network 
provider.
 ``
            (d) Epinephrine Delivery System Defined.--In this section, the 
term `epinephrine delivery system' means a delivery system approved by 
the Food and Drug Administration for the administration of epinephrine, 
including any auto-injector, nasal spray, or sublingual delivery system 
that is so approved.''.

    (b) ERISA.--

    (1) In general.--Subpart B of part 7 of subtitle B of title 
 I of the Employee Retirement Income Security Act of 1974 (29 
 U.S.C. 1185 et seq.) is amended by adding at the end the 
 following new section:

``

SEC. 726. REQUIREMENTS WITH RESPECT TO COST SHARING FOR EPINEPHRINE 
 DELIVERY SYSTEMS.

 ``

    (a) In General.--A group health plan, and a health insurance 
issuer offering group health insurance coverage, shall provide coverage 
of epinephrine delivery systems, and with respect to such delivery 
systems, may not--
 ``

    (1) apply any deductible; or
 ``

    (2) impose any cost sharing in excess of $60 per package 
 of 2 delivery systems (or the equivalent).
 ``

    (b) Application of Cost Sharing Toward Deductibles and Out-of-
Pocket Maximums.--Any cost-sharing payments made pursuant to subsection

    (a)

    (2) shall be counted toward any deductible or out-of-pocket maximum 
that applies under the plan or coverage.
 ``
            (c) Out-of-Network Providers.--Nothing in this section requires a 
plan or issuer that has a network of providers to provide benefits for 
an epinephrine delivery system described in this section that is 
delivered by an out-of-network provider, or precludes a plan or issuer 
that has a network of providers from imposing higher cost sharing than 
the levels specified in subsection

    (a)

    (2) for an epinephrine delivery 
system described in this section that is delivered by an out-of-network 
provider.
 ``
            (d) Epinephrine Delivery System Defined.--In this section, the 
term `epinephrine delivery system' means a delivery system approved by 
the Food and Drug Administration for the administration of epinephrine, 
including any auto-injector, nasal spray, or sublingual delivery system 
that is so approved.''.

    (2) Clerical amendment.--The table of contents in 

section 1 
 of the Employee Retirement Income Security Act of 1974 (29 
 U.S.C. 1001 et seq.) is amended by inserting after the item 
 relating to 

section 725 the following:

``

Sec. 726. Requirements with respect to cost sharing for epinephrine 
 delivery systems.''.
            (c) IRC.--

    (1) In general.--Subchapter B of chapter 100 of the 
 Internal Revenue Code of 1986 is amended by adding at the end 
 the following new section:

``

SEC. 9826. REQUIREMENTS WITH RESPECT TO COST SHARING FOR EPINEPHRINE 
 DELIVERY SYSTEMS.

 ``

    (a) In General.--A group health plan shall provide coverage of 
epinephrine delivery systems, and with respect to such delivery 
systems, may not--
 ``

    (1) apply any deductible; or
 ``

    (2) impose any cost sharing in excess of $60 per package 
 of 2 delivery systems (or the equivalent).
 ``

    (b) Application of Cost Sharing Toward Deductibles and Out-of-
Pocket Maximums.--Any cost-sharing payments made pursuant to subsection

    (a)

    (2) shall be counted toward any deductible or out-of-pocket maximum 
that applies under the plan.
 ``
            (c) Out-of-Network Providers.--Nothing in this section requires a 
plan that has a network of providers to provide benefits for an 
epinephrine delivery system described in this section that is delivered 
by an out-of-network provider, or precludes a plan that has a network 
of providers from imposing higher cost sharing than the levels 
specified in subsection

    (a)

    (2) for an epinephrine delivery system 
described in this section that is delivered by an out-of-network 
provider.
 ``
            (d) Epinephrine Delivery System Defined.--In this section, the 
term `epinephrine delivery system' means a delivery system approved by 
the Food and Drug Administration for the administration of epinephrine, 
including any auto-injector, nasal spray, or sublingual delivery system 
that is so approved.''.

    (2) Clerical amendment.--The table of sections for 
 subchapter B of chapter 100 of the Internal Revenue Code of 
 1986 is amended by adding at the end the following new item:

``

Sec. 9826. Requirements with respect to cost sharing for epinephrine 
 delivery systems.''.
            (d) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2026.
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