By Julie Watts


SAN FRANCISCO (KPIX) – State regulators are investigating complaints about Kaiser’s new EpiPen policy, following a KPIX 5 original report.

On Aug. 17 we revealed parents were outraged to learn that Kaiser will now only fill half of their child’s lifesaving epinephrine prescription, but continues to charge patients the full price.

Some also complain that Kaiser is handing out the partial prescriptions without the legally required prescription labels. In some cases, the practice may even prevent schools from being able to administer the life-saving drug.

Epinephrine auto-injectors are used to treat potentially deadly food allergy reactions. There is currently a shortage of the EpiPen brand injector as well as the generic alternative that Kaiser offers its patients. As a result, Kaiser began rationing its injectors.

However, patients point out that there is a third brand that Kaiser could offer and so far it appears that Kaiser is the only provider that is refusing to fill full prescriptions.

Many in the food allergy community were shocked when KPIX revealed the current Kaiser policy of splitting up the epinephrine two-packs.

As food allergy advocates pointed out that the emergency medication is prescribed in a two dose package for a reason. The first pen may fail, and many need more than one dose to survive.

“We were really concerned when we saw your report,” said Jen Madsen with FARE (Food Allergy Research & Education). “Our reaction was that it’s unconscionable.”

The FDA approved the epinephrine auto-injector for distribution in a two-pack box. According to the FDA, a pharmacist could only reduce a prescription to one pen if that’s specifically what the doctor prescribed.

However, KPIX heard from dozens of patients who complained that Kaiser pharmacists were only providing them with one pen despite their prescription for the full two-syringe box.  Many questioned whether splitting the prescriptions and charging multiple co-pays was even legal.

“Generally we would expect the pharmacy to fill it as it is written,” said Virginia Herold with the California State Board of Pharmacy.

California State Board of Pharmacy officials are urging those affected by the policy to file a complaint. The organization has now opened an investigation into the rationing.

One of the greatest concerns following our August 17 report was the accusation that some patients were given a single pen without proper labeling.

“If there’s not label it’s a violation of our law,” said Herold.

While Kaiser claims it is rationing, some patients note that Kaiser is making double the money by charging the full co-pay for half of the prescription.

“I did question if it was legal,” said parent Beth Gomez. “They said it was fine because of the shortage.”

Gomez said Kaiser charged her two co-pays at the same time for what would otherwise have been just one full prescription.

When she went in to fill prescriptions for each of her two kids, she says the pharmacist opened the two-pack box, handed her the two pens separately and charged her twice the price she would normally pay for the one two-pen box.

“Generally speaking, you can only be charged one co-pay for each prescription,” said California Insurance Commissioner Dave Jones.

Jones said people who feel they’ve been charged unfairly should file an additional complaint with the Department of Insurance. The Pharmacy Board does not have jurisdiction over prescription pricing. The Department of Insurance regulates co-pays and pricing.

Meanwhile, while there is a shortage of the EpiPen brand and the generic that Kaiser provides, there are alternatives like the AUVI-Q injector that are currently plentiful.

AUVI-Q tells KPIX that there is no shortage of their epinephrine injectors and Kaiser’s own policy states that the insurer will cover AUVI-Q injectors for patients during a national shortage of other brands. However, one parent told KPIX that she was told she’s have to pay full price for an AUVI-Q prescription.

Because Kaiser is an HMO — serving as the provider, the insurer and the pharmacy — Kaiser patients generally don’t have the option of shopping around.

“I don’t know what my choices are at this point,” she said.

KPIX spoke to a representative of the company that manufactures AUVI-Q , which on Thursday night said it would provide its version of the EpiPen at no cost for Kaiser patients during the shortage.

The AUVI-Q injector is available for $0 out-of-pocket for all those with commercial insurance and those without commercial insurance who have a household income lower than $100,000.  For those who don’t fall into that category, the price is $360 for a two pack and trainer.

Meanwhile, KPIX reached out to Kaiser again Thursday. The HMO provided essentially the same statement they sent us last week.

That statement read:

We are aware of and have been monitoring the national shortage of Epipen. To preserve supplies for all Kaiser Permanente members who need this medication, until supplies become normal again, we are providing no more than 1 syringe at a time for most patients.

While the FDA approved this product to be on the market as a two-pen set, physicians have the discretion to prescribe this drug as clinically appropriate. Our physician groups have endorsed the splitting of these packages to preserve supplies during the shortage. Once supplies return to normal, the one-syringe limit will be removed. We are working with other manufacturers of epinephrine auto-injectors concerning supplies.

Pharmacists may dispense more than 1 prescription for high-risk patients with a documented need based on the patient’s refill history or when advised by the patient’s physician. Our pharmacists are having conversations with patients when they pick up their prescription, so they understand why they are only receiving 1 auto-injector, can discuss any concerns and receive a second if they have a documented need.

Kaiser Permanente is committed to delivering high-quality, safe care. We have listened to our members and understand their concerns about the prescription co-pay. We are currently investigating options to address this situation.

However, after we published Kaiser’s statement last week, patients reached out to KPIX to clarify that their Kaiser physicians continue to write prescriptions for the full two-does packages. Some viewers said their doctors even called the pharmacy to lobby on their behalf but the pharmacists continue to refuse to fill the full prescriptions.

{This story has been updated}

Comments (2)
  1. Christine Zhu says:

    You should request for people to file with the CA Department of Managed Health Care, not Department of Insurance since they do not regulate HMO products such as Kaiser.

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