Ohio bill would allow pharmacists to substitute for high-priced epinephrine prescriptions

If passed, HB 101 would also allow adults to obtain epinephrine without a prescription

In response to a national outcry about the soaring cost of EpiPen, an Ohio state legislator has introduced a bill that would facilitate competition by granting pharmacists the authority to substitute epinephrine autoinjectors without requiring a new prescription from a physician. HB 101, the Epinephrine Accessibility Act, introduced by Ohio Rep. Derek Merrin, allows pharmacists to recommend an epinephrine product other than the one prescribed—whether from a cost, ease of use, or effectiveness standpoint—as long as it still meets a patient’s needs. The bill aims to give patients more access to affordable options.

Because of differences in autoinjector device specifications, pharmacists can’t seamlessly substitute lower-cost alternatives to EpiPen, which dominates the marketplace. “Pharmacists’ hands are tied when a prescription for a brand-name epinephrine product comes in, because there are few available generics,” said Antonio Ciaccia, director of government and public affairs at the Ohio Pharmacists Association.

The bill targets a pricing structure that incentivizes high prices. Rebates lead PBMs to keep EpiPen on their formularies even when it is not the least-expensive or most-effective option. “HB 101 alleviates the administrative burden of going back to the physician, and it works to inject marketplace competition at the pharmacy counter and challenge the dysfunctional PBM rebate structure,” Ciaccia said.

A second component would allow pharmacists to provide epinephrine products to adults without a prescription under a standing order, similar to the procedure Ohio already has in place for immunizations and naloxone.

“If you’ve had a peanut allergy all your life, it’s unnecessary and wasteful to have to go back to the doctor every year,” Ciaccia said.

“Pharmacists have been way too often overlooked to alleviate health care’s most pressing issues, like disease management and identifying medication misuse,” he added. “This is the lowest of low-hanging fruit as far as how to utilize pharmacists in the future.”