ALAMOSA, Colo — Kent Holtcamp has been on a scavenger hunt for something he was promised by state law.
His daughter, a teacher in Greeley is severely allergic to nuts – so much so that she once went into anaphylactic shock when someone was roasting pecans. She uses an epinephrine injector to protect her if she’s ever exposed.
Holtcamp, who lives in Alamosa, said a friend told him about a new state law that caps the out-of-pocket cost for the drug at $60. So, he told his daughter, and she asked about it at pharmacies in Northern Colorado.
“She said ‘Papa, you told me it was 60 bucks,'” Holtcamp said. “And I said, 'It is,' and she goes 'No, the cheapest one I can get is $270.'”
So, Holtcamp called around pharmacies in the San Luis Valley, Denver and Fort Collins and said he was met with the same news.
“All three of them said basically the same thing that apparently there's some paperwork that they wait for,” he said.
Timothy Johnson found the same when he asked his Denver pharmacist about the drug for his young son who is allergic to peanuts.
“The best they could do was the manufacturer was going to offer us a $10 discount, which brought the price from around to at around $280 to $270,” he said.
Johnson, a teacher in Denver, said his family can afford the extra cost, but as a school leader, he’s worried about families who may be in the same boat without the right resources.
“I hope that there's some clarity on it for people to move forward,” he said.
Holtcamp and Johnson are two of several consumers who’ve contacted Steve On Your Side wondering why pharmacists haven’t made the program available months after the law went into effect.
State Rep. Javier Mabrey, D-Denver, who co-sponsored HB23-1002, is also hearing from constituents frustrated by not getting the right price.
“Specifically, what's happening is we’re hearing from pharmacies that manufacturers aren't honoring the reimbursement like they're supposed to under the law,” he said. “The way this bill is designed is the manufacturers are supposed to reimburse the pharmacies, either for the extra cost or straight up by giving them extra Epi-Pens.”
The law caps the cost insurance providers can require patients to pay at $60. It also created a program for uninsured patients who need the drug to also pay $60. And the law requires that if a pharmacist has to accept only the $60 payment from an uninsured patient, drug manufacturers are required to reimburse pharmacists the rest of the cost they paid to carry the drug, or the manufacture can make the pharmacy whole by providing new injectors.
“I think we passed this law thinking that people would follow the plain letter of the law, there are even some penalties built in here, but we just haven't seen universal compliance with this law,” Mabrey said.
But pharmacists tell 9NEWS the law or the agency overseeing it never established a protocol for seeking reimbursement from a manufacturer. Emily Zadvorny, CEO of the Colorado Pharmacists Society, said pharmacists are often paying hundreds of dollars for a single two-pack injector kit to sit on their shelves.
“They’re saying 'I can't do that. I can't lose hundreds of dollars to get you this prescription for $60”' she said. “So, there have been situations where they've said, 'I just can't help you,' and they've turned that patient away.”
“We've got to get a process that the state or [the Department of Regulatory Agencies] or the Board of Pharmacy or someone puts out there, this is what you do, and this is how you get reimbursed, and this is how it goes.”
Teva Pharmaceuticals, the manufacturer of the brand name Epi-Pen, sued the state last fall, calling the law requiring them to reimburse pharmacists for a cost-capping measure unconstitutional. A federal judge denied a motion for an injunction that would have stopped the law. Steve On Your Side reached out to the company for a comment on this story, but a spokesperson has yet to respond to the request.
Mabrey said the law already includes penalties for manufacturers who violate it by not reimbursing a pharmacist. He said a legislative fix may be required this session to beef up enforcement for the law.
“We expected to see some resistance for sure,” he said. “But I expected that to look more like litigation. But I did not expect, necessarily, for people to just straight up not comply with the plain letter of the law.”
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