Austin Alert: Brand Name EpiPen Coverage Changes

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Austin Alert EpiPen Coverage Changes

Carriers have begun to announce that they will no longer cover the brand name EpiPen® (epinephrine injection, USP) 0.3mg and EpiPen Jr ® (epinephrine injection, USP) 0.15mg, due to the release of a new authorized generic. EpiPen injectors are used to treat allergic reactions.

Authorized generics have the same drug formulation and auto-injector device functionality as the brand name products. The authorized generics are manufactured by Mylan, who also manufactures the brand name EpiPen and EpiPen Jr.

Prescriptions written for EpiPen and EpiPen Jr are interchangeable with their authorized generic products. Authorized generics aren’t considered generic and will require members to pay a brand copay. 

The Difference between Generics and Authorized Generics:

Generics Drugs: a copy of the original brand name drug, it has the same active ingredients, dosage form, strength, route of administration, and intended use as the brand drug. Must be approved as an Abbreviated New Drug Application (ANDA) by the FDA.

Authorized Generic Drugs: the brand company’s own product (approved as a New Drug Application (NDA) by the FDA) repackaged and marketed as a generic drug either through a subsidiary or a third party. It also has the identical color, size, shape, flavor, dosage form, strength, route of administration, active ingredients, and inactive ingredients as the brand drug.

Mylan will offer a savings card for the authorized generic for eligible patients with commercial insurance, and will also continue the existing EpiPen savings card. Find out more on Mylan’s website.

FOR BLUE CROSS BLUE SHIELD OF MICHIGAN AND BLUE CARE NETWORK GROUPS

The following table compares prices between the excluded brand name and their authorized generics:

Brand Name Drugs not covered, beginning March 1CostCovered AlternativesCost
EpiPen (epinephrine injection, 0.3 mg)$730*Epinephrine 0.3 mg auto-injector 2-pak$375*
EpiPenJr (epinephrine injections, 0.15 mg)$730*Epinephrine 0.15 mg auto-injector 2-pak$375*
*Approximate cost per package based on average wholesale price

 

A member letter will be sent by the Blues prior to March 1 to those who have recently purchased one of these medications to let them know about this change. A group letter will also be sent to your administrative contact if you have an employee who recently filled one of these medications. 

Members who continue to fill prescriptions for the brand name EpiPen or EpiPen Jr on or after April 1, 2017 will be responsible for the full cost. 

FOR PRIORITY HEALTH GROUPS

The following table compares prices between the excluded brand name and their authorized generics:

Brand Name Drugs not covered, beginning March 1CostCovered AlternativesCost
EpiPen (epinephrine injection, 0.3 mg)$600*Epinephrine 0.3 mg auto-injector 2-pak$300*
EpiPenJr (epinephrine injections, 0.15 mg)$600*Epinephrine 0.15 mg auto-injector 2-pak$300*
*Approximate cost per package based on average wholesale price

 

 

A member letter will be sent by Priority Health prior to March 1 to those who have purchased EpiPen in the past year to let them know about this change in coverage. 

If members already have a prescription for EpiPen or EpiPen Jr. their pharmacy will substitute the authorized generic product.

 

If you have any questions or concerns, please do not hesitate to reach out directly to your dedicated account manager or call us at 248.594.5550.