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