H.R. 5139 — EPIPEN Act

This section requires group health plans and health insurance issuers offering group or individual health insurance coverage to cover epinephrine delivery systems (i.e., FDA-approved auto-injectors, nasal sprays, or sublingual systems for epinephrine administration) without any deductible and with cost sharing not exceeding $60 per package of two delivery systems (or equivalent), for plan years beginning on or after January 1, 2026. Such cost-sharing payments count toward applicable deductibles and out-of-pocket maximums; plans with provider networks are not required to cover out-of-network epinephrine delivery systems and may impose higher cost sharing for them. The requirement is codified in the Public Health Service Act (adding section 2799A–11), ERISA (adding section 726), and the Internal Revenue Code (adding section 9826).