A large private insurance company and at least five state Medicaid programs are now pushing alternative epinephrine auto-injectors instead of the branded EpiPens.

Cigna (CI), an insurance company that serves about 15 million patients, recently changed its policy: Branded EpiPen and Adrenaclick auto-injectors will no longer be covered without a “prior authorization” from the company. Additionally, in at least three states, Medicaid recipients must obtain prior approval before buying one of the brand-name auto-injectors with insurance, and in at least five states, EpiPens are only covered with a prior authorization.

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