LINCOLN, Neb. (Nebraska Examiner) – Lawmakers took a step Wednesday to cap the out-of-pocket cost for epinephrine injectors and ensure Nebraska schools and licensed child care programs have policies to respond to allergic reactions.

Legislative Bill 457, from State Sen. Eliot Bostar of Lincoln, advanced 31-0 to the second stage of debate. It would limit out-of-pocket costs for medically necessary epinephrine injectors, including EpiPens, to no more than $60 for a two-pack, regardless of the type.

Bostar said some generic injectors can cost between $320 and $750, while name brand injectors can cost between $650 to $730. If passed, the cap would take effect Jan. 1, 2026.

“The absence of a cure for life-threatening food allergies underscores the critical importance of epinephrine auto injectors for preventing fatal anaphylaxis, which is a life threatening allergic reaction that, without prompt administration of epinephrine, the consequences can be dire,” Bostar said at his bill’s Feb. 10 hearing.

Dr. Hanna Niebur, a board-certified physician specialized in pediatrics and allergy immunology, spoke in favor of the bill at its hearing. She represented the Nebraska Medical Association and the Nebraska Academy of Allergy, Asthma and Immunology.

Niebur said LB 457 would save lives and that she’s seen firsthand the “terrifying speed at which anaphylaxis can take hold.”

“Starts with itching or swelling but within minutes, a child may struggle to breathe as their airway swells shut,” Niebur testified. “Without immediate access to epinephrine, anaphylaxis can be fatal.”

Bostar noted at the hearing that an eighth-grader in a Papillion school died three years ago at the age of 14 after a severe allergic reaction from eating a granola bar with peanuts that his teacher had given him. Papillion-La Vista Public Schools paid a $1 million settlement in connection to the teen’s death.

Roughly 200,000 Nebraskans have food allergies, and more than 36,000 are children, Bostar said.

LB 457 would require the Nebraska Department of Health and Human Services and the Nebraska Department of Education to create model policies for preventing and responding to anaphylaxis.

The policies would need to include:

• Procedure and treatment plans, including emergency protocols and responsibilities for child care staff, school nurses and other school staff.
• Appropriate guidelines for developing and implementing an individualized health care plan for children with an allergy that could result in anaphylaxis.
• Communication plans for the intake and dissemination of information provided by the state regarding children with an allergy that could result in anaphylaxis, including methods, treatments and therapies to reduce the risk of allergic reactions.
• Strategies for reducing the risk of exposure to allergens.
• Communication plans for discussing with children and all parents or guardians of children attending the school district or a licensed child care program about foods that are safe and unsafe and strategies to avoid exposure to unsafe food.

Licensed child care providers or schools without an anaphylaxis prevention and response policy would need to adopt one by July 1, 2026. Officials could adopt the model policy put forward by the state.

Niebur, speaking at the hearing, said financial barriers should never determine whether a child lives or dies.

While the Department of Education already requires schools and approved early childhood education programs to have an emergency response plan for life-threatening asthma or anaphylaxis, there is no universal standard, Niebur said, so the bill would provide “consistent, medically sound guidance.”

About 11% of schools report at least one episode of anaphylaxis each year, she added.

Robert Bell, executive director for the Nebraska Insurance Federation, said many health plans already cap out-of-pocket costs for EpiPens.

His organization was “neutral” on the bill, “because the Federation understands the lifesaving nature of EpiPens in emergencies but generally opposes health care insurance mandates.”

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