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HB 101: Better utilizing pharmacists to ease epinephrine access

Guest Editorial

HB 101: Better utilizing pharmacists to ease epinephrine access

Ohio Representative Derek Merrin (R-Monclova Township)

On February 28, I was honored to speak at the OPA Pharmacy Student Legislative Day, where I informed students that earlier that morning I introduced House Bill 101, legislation aimed at empowering pharmacists to help address epinephrine accessibility and affordability for Ohioans. The “Epinephrine Accessibility Act” will expand the role of the pharmacist, while saving patients money and time. HB 101 has garnered national attention pitting pharmacists and patient advocates against the entrenched status quo – and those who profit from it.

Media have reported on the sky-rocketing cost for EpiPens, which are a brand of epinephrine auto-injectors used for severe, life-threatening allergic reactions. The price for EpiPens has increased about 500 percent in recent years, standing at around a $600 retail price. EpiPen sales account for about 90 percent of the epinephrine auto-injector market. I believe that Mylan Pharmaceuticals, the drug maker of EpiPen, is exploiting its virtual monopoly in the epinephrine auto-injector space. For those at-risk of anaphylactic shock, epinephrine auto-injector prices have become a barrier to access and attainability.

HB 101 allows pharmacists to substitute a prescribed brand-name epinephrine auto-injector for a pharmaceutically equivalent epinephrine auto-injector from a competing manufacturer. For example, if a physician prescribes EpiPen that retails at ~$600, a pharmacist would be able to substitute a less expensive alternative that could retail as low as $100. The patient must consent to substitution, and the prescribing physician’s ability to direct the pharmacist to dispense a specific product is still protected. Under current state law, pharmacists are prevented from substituting branded epinephrine auto-injectors.

By allowing pharmacists to substitute epinephrine auto-injectors, consumers could save hundreds of dollars annually. Most importantly, consumers who cannot afford the life-saving medication would be provided less expensive alternatives. While developing HB 101, I have had pharmacists inform me that EpiPens have a high abandonment rate. Those pharmacists have told me that they attribute this abandonment to the high price of the drug. Pharmacists have relayed many personal stories to me about parents who neglect to fill EpiPen prescriptions because of the price, walking out of the pharmacy without the potentially life-saving medication their child needs. HB 101 would empower pharmacists to educate, inform, and counsel consumers on the multiple epinephrine auto-injectors available. Consumers would be better positioned to make the best choice for themselves and their families.

This legislation would also allow pharmacists, under a protocol with a physician, to dispense epinephrine auto-injectors to those 18 years or older without a prescription. The Ohio Board of Pharmacy, with consultation of the Ohio State Medical Board, would establish guidelines and requirements for a protocol that would govern the conditions under which pharmacists could dispense epinephrine. This provision could save consumers from unnecessary, time-consuming visits to physician offices and costly co-pays to obtain a prescription that an adult has been reliant on for many years. HB 101 is modeled after the naloxone legislation (House Bill 4 from the 131st General Assembly) that sought common-sense reform to increase access to a life-saving drug.

In the 131st General Assembly, Ohio enacted House Bill 200 that enabled a clinical nurse specialist, nurse practitioner, or certified nurse-midwife with a certificate to prescribe epinephrine. This law, which passed both chambers unanimously, set a standard that a personal evaluation or medical exam is not necessary to prescribe epinephrine auto-injectors. The legislature has duly recognized that epinephrine is an emergency, life-saving medication and should be readily available to the public. As pharmacists know, epinephrine is a non-addictive, non-controlled substance, and is not deemed a drug of abuse. Also, the legislation eases the ability for restaurants, colleges, amusement parks, and sports facilities to obtain the product if they fear there is a risk for allergic reactions on their premises.

Drugs delivered by a mechanical device have stifled substitution efforts, because FDA will not approve generic equivalents due to the different delivery mechanisms. HB 101 has sparked a valuable discussion and breaks new ground on the substitution aspect of pharmaceuticals delivered by devices. From a state law perspective, the legislation is a tangible step to partially addressing exorbitant drug prices. It takes positive steps in advancing competition and transparency, and empowering pharmacists.

The Epinephrine Accessibility Act has strong momentum, but its passage is not guaranteed. All pharmacists should join together and contact their state lawmakers to support HB 101. The most effective advocates in public policy are industry professionals, such as pharmacists. Ohio legislators need to hear from pharmacists in their districts. All Ohioans will benefit when pharmacists, the pharmaceutical professionals, push for common-sense pharmacy reforms. Together, we will increase the access and affordability of many drugs, in this case, epinephrine auto-injectors.

OPA Members Provide Testimony on HB 101

In March, hearings on HB 101, Rep. Derek Merrin’s “Epinephrine Accessibility Act,” commenced in the Ohio House of Representatives Health Committee. Rep. Merrin delivered sponsor testimony, and the following week, OPA coordinated proponent testimony.

On March 22, OPA members Kelli Barnes (Ohio State University College of Pharmacy and Division of General Internal Medicine) and Suzi Francis (Kroger Pharmacy, Cincinnati Division) delivered testimony to committee members in support of the legislation. They were joined by OPA Director of Government & Public Affairs Antonio Ciaccia to explain the value of the bill and the need to expand the role of the pharmacist.

Barnes and Francis did an excellent job as ambassadors for the profession, and their testimony was very well received.

We would also like to thank Lora Miller with the Ohio Council of Retail Merchants & Affiliates, as well as OPA members Pete Ratycz, Jason Briscoe, and Steve Ferris for submitting written testimony in support of the legislation.

Hearings were expected to continue in April, where we hope to advance the legislation through the committee. Members are encouraged to contact their legislators to support HB 101.

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