EPIPEN Act Caps Emergency Allergy Injector Costs at $60, Eliminates Deductibles Starting 2026

The “Epinephrine’s Pharma Inflated Price Ends Now Act,” or the EPIPEN Act, is straight-up good news for anyone who carries one of these life-saving devices. This bill targets the notorious high cost of emergency allergy medication by putting a hard cap on what insurance plans can charge you out-of-pocket for an epinephrine delivery system, like an EpiPen auto-injector.

The $60 Safety Net

Starting with plan years on or after January 1, 2026, if you have group or individual health insurance, your plan must cover epinephrine delivery systems. The biggest win here is the cost cap: your copay or co-insurance for a package containing two delivery systems cannot exceed $60. This is a massive change, especially for families who currently pay hundreds of dollars annually just to keep these devices current and available in their homes, cars, and schools. Think of the parent juggling two kids with severe allergies; this bill provides immediate, predictable financial relief.

No More Deductible Games

Beyond the $60 cap, the bill also mandates that plans cannot apply any deductible to these systems at all. If you're used to hitting a $2,000 deductible before your prescriptions get affordable, this means your EpiPen is covered from day one. Even better, that $60 you do pay must count toward your overall annual deductible and your out-of-pocket maximum. So, you’re not just paying a flat fee; you’re making progress toward meeting your yearly spending limit, which is a smart piece of consumer protection written right into the law (Sec. 2).

The Fine Print: Where the Cap Doesn't Apply

While the bill is clear and impactful, it’s crucial to note where the $60 benefit stops. If your health plan has a network—which most do—the $60 cap only applies if you get the epinephrine system from an in-network provider. The bill explicitly states that if you go out-of-network, the plan is allowed to charge you more than the $60 limit. For people in rural areas or those dealing with supply chain issues who might be forced to use an out-of-network pharmacy, this is the one provision that could still leave them exposed to high costs. This is a practical challenge that could affect how people access this necessary medication, even with the new law in place. The definition of the covered system is broad, covering any FDA-approved device, including auto-injectors and nasal sprays, which future-proofs the bill as new technology emerges.

What Happens Next

This new rule is being applied across the major laws governing health insurance (the Public Health Service Act, ERISA, and the Internal Revenue Code), ensuring it hits employer-sponsored plans and individual market plans alike. The delay until 2026 gives insurance carriers time to adjust their plan designs and pricing models. For consumers, this means financial predictability is coming, though you won't see the change reflected in your plan until your next enrollment cycle starting in 2026.