Legislation aims to increase access to lifesaving allergy medication in schools

OLYMPIA – Schools may see increased access to lifesaving allergy medication thanks to a bill that would allow them to stock epinephrine vials and autoinjectors.

Injected into the thigh, epinephrine is the only medication that works to prevent and counteract anaphylaxis, a life-threatening allergic reaction to food, medication, latex, insect sting or other allergens.

Schools are currently only allowed to stock epinephrine autoinjectors, more commonly known as EpiPens, for when a student has a severe allergic reaction. However, this year’s legislation would allow schools to house vials of the drug, which school nurses or other trained people could administer via syringe.

The bill now awaits Gov. Jay Inslee’s signature to become law after passing unanimously through the House and Senate.

Some schools in Spokane County have already seen increased access to epinephrine autoinjectors with a standing order issued last year by County Health Officer Dr. Francisco Velázquez. The order allows schools to stock additional autoinjectors, though some schools don’t use the standing order because of district policy.

Helping keep students with severe allergies safe remains a high priority for school districts. At the Central Valley School District, for example, some 325 students out of about 14,700 have a life-threatening allergy that requires an autoinjector, said Heather Graham, the school district’s lead nurse.

To carry an EpiPen, these students must have a medical provider’s order and, depending on their age and parental consent, either the student or the nurse is responsible for its possession, she said.

Spokane Public Schools has about 600 students with a life-threatening allergy, spokesman Ryan Lancaster said in an email, out of the nearly 30,000 students.

Each time a student has an allergic reaction needing epinephrine, whether that student has an autoinjector prescription on file or not, 911 is always called.

Prime Sponsor Rep. Dan Bronoske, D-Lakewood, who works as a firefighter, said it’s current practice at his fire department to dispense epinephrine out of a vial rather than using an EpiPen for three reasons.

“One: they’re expensive. Two: they could be difficult to access with supply chain issues. And three: they expire after about a year and it creates quite a bit of waste,” he said on the House floor on Jan. 25.

While a two-dose pack of name-brand EpiPens can cost upwards of $600, a vial of epinephrine is usually much cheaper, ranging from $20 to $30. However, both usually expire within a year.

“What I’m looking to do here is offer some flexibility for school districts to save money, save lives and give better access to rural school districts that might not have access to (emergency medical services),” Bronoske said.

The bill requires the Secretary of Health or an appointee to issue a statewide standing order prescribing both vials of epinephrine and autoinjectors to schools so school nurses or other trained health care personnel can administer treatment if a child is experiencing an allergic reaction even if they don’t have a current prescription on file.

“Our district would have to update our board policy and administrative procedure should this bill pass, because we don’t currently have a policy or procedure that allows stock epinephrine autoinjectors,” Graham said.

Spokane Public Schools has a similar policy and doesn’t currently stock additional epinephrine, though it is a conversation their schools might have in the future, Lancaster said.

The only change schools in Spokane County would see is a stock of epinephrine vials, because Velázquez’s standing order already allows them to house additional autoinjectors.

“But this will have a big impact on rural districts or other districts who may not have access to health districts or medical providers writing a standing order to cover their county,” Graham said.

Under the order, school nurses or any school personnel who administer epinephrine to a child are protected and cannot be held liable.

Another bill aimed at reducing the cost of EpiPens is headed for the governor’s desk. That bill would place a $35 cap on EpiPens and inhalers for individuals who are part of a health plan or covered by insurance. It unanimously passed the House and Senate.