Epi-Pen® coverage update

Epi-Pen, an emergency allergy injection device, has recently been in the news due to substantial price increases over the past few years. Updates to the BCBSRI Commercial formularies as of April 1, 2017 changed the way this and similar devices are covered. These changes are intended to ensure these potentially life-saving devices are made accessible and affordable for BCBSRI members.

Generic versions of Epi-Pen authorized by the same manufacturer as the brand are now available on a lower tier, with a lower copayment for many members. These generic versions contain the same ingredients as the brand versions of Epi-Pen, but cost less. However, the authorized generic versions did not receive an interchangeable designation from the FDA. This means pharmacies will not be able to dispense the generic version for prescriptions written specifically for Epi-Pen. Prescribers can write the prescription for an Epinephrine Auto-Injector (Epi-Pen generic) to allow the pharmacy to dispense the new lower tier product without delay.

Alongside these changes, Adrenaclick®, a similar device containing the same medication, and its generic version are now covered on the non-preferred brand tier. The brand versions of Epi-Pen and Auvi-Q® (which was recently reintroduced to the market following a recall) will be excluded from the formulary.