Cigna, Medicaid Programs Won’t Cover Brand EpiPens Without First Giving Prior Authorization

Cigna has jumped into the ongoing EpiPen controversy with both feet with its decision to not cover the brand version of the product without first giving prior authorization, STAT reports. With about 15 million beneficiaries, Cigna is the first major health insurance company to take this stand. Cigna also insists on giving prior authorization to an EpiPen competitor, Adrenaclick.

Medicaid is also taking a harder stance. In three states, Medicaid recipients need to get prior approval for the brand auto-injectors, while in at least another five states beneficiaries must obtain prior authorization.

Mylan markets both the EpiPen and a generic version and the company says it wasn’t thrown off-guard by Cigna’s decision. “These formulary changes were anticipated and are why we anticipate successful generic utilization,” a Mylan spokesperson tells STAT. About the moves some Medicaid plans are making, the spokesperson wrote that off as just the “normal course of business for pharmaceutical products.”

EpiPen has been much in the news lately because the branded version’s cost increased 450% since 2004, sparking consumer and legislative outrage. The branded version costs $608 per two-pack; the generic version costs $300 per two-pack. The generic for  Adrenaclick costs about $400 per two-pack. It, and the entire pharmaceutical industry, are also in the news because combating the exorbitant prices of medications has become a battle cry across the political spectrum. President-elect Donald Trump vows to do something about it; former presidential candidate and socialist Sen. Bernie Sanders agrees.

EpiPen is an injection containing epinephrine, which increases blood pressure, relaxes lung muscles to reduce wheezing and improve breathing, stimulates the heart, and reduces hives and swelling around the face and lips.

STAT reports that, “In an investor note this week that didn’t mention the insurance coverage changes, Bernstein analyst Ronny Gal estimated that EpiPen sales will fall from $1.1 billion in 2016 to $300 million in 2018, including both the brand and generic products.”

Source: STAT