We often receive inquiries about neffy — the needle-free alternative to epinephrine auto-injectors — chief among them concerns about insurance coverage for the device.
We recently received an update from ARS Pharmaceuticals, the company behind neffy, providing the recent state of coverage by major insurers. While some insurers have been quick to cover neffy, others are delaying coverage and need pressure from their constituents before they will act.
Here follows the current state regarding coverage and suggestions for those for whom coverage is difficult or unavailable.
Preferred Unrestricted Coverage (30% of patients)
These insurance companies currently provide unrestricted coverage for neffy without prior authorizations and typically with low co-pays. This coverage should qualify most individuals for the $25 copay with ARS copay assistance with a coupon available from www.neffy.com (which will hopefully be pre-loaded soon at CVS pharmacies).
- Express Scripts
- Cigna Healthcare
- Navitus
- OptumRx (effective February 13, 2025)
Non-Preferred Unrestricted Coverage (7% of patients)
These insurance companies also provide unrestricted coverage for neffy without prior authorizations, but they may have higher co-pays. ARS copay assistance with a coupon from www.neffy.com can potentially reduce the patient’s out-of-pocket expenses, but it is limited to a $200 discount (thus, any deductible below $225 would result in the patient paying $25, but higher if deductible is higher that this amount).
- Medimpact
- New York Employees
- Other smaller insurance companies
Non-Preferred with Step Prior Authorization (11% of patients)
These insurers cover neffy but require prior authorization and the use of an autoinjector before prescription. This practice poses challenges, as new patients may be forced to use a generic autoinjector, disregarding their preference for a needle-free option.
- Anthem
- Tricare
- Blue Shield of California (BS of CA)
- Highmark Blue Cross Blue Shield (BCBS BCBS NC)
- Several other insurers
Not Covering — Blocked by Insurer (52% of patients)
These insurers do not cover neffy without prior authorization. Notably, some insurers require more significant approval processes due to the situation and its impact on patients and caregivers.
- CVS Caremark
- United Healthcare
- FEP Blue
- Aetna
- Blue Cross Blue Shield of HSCS (BCBS HSCS)
- Blue Cross Blue Shield of Massachusetts (BCBS of MA)
- Prime
- Blue Cross Blue Shield of Michigan (BCBS MI)
- Florida Blue
Important notes for those covered by these insurers:
- CVS Caremark (Zinc), the largest pharmacy benefits manager in the United States, represents 19.5% of the commercially insured. Zinc is expected to approve neffy coverage by the end of February. However, its inclusion on the CVS Caremark formulary may be delayed until July 1st due to bureaucratic processes without substantial public pressure.
Caremark placing neffy on its formulary is important, as this is influential in the approval of neffy coverage by Anthem (4.1%) and Aetna (4.1%), both of which use Zinc as a Group Purchasing Organization (GPO).
If Zinc, Anthem, or Aetna govern your coverage, you are urged to contact the insurer and insist that access to neffy — the only needle-free device available — is critical to your family’s well-being and should be added to its formulary and coverage ASAP.
- United Healthcare and OptumRx both use Emisar as their GPO for pharmacy benefits. Although neffy is already on OptumRx’s formulary, United Healthcare has the authority to cover neffy based on the terms approved by Emisar and accepted by OptumRx. Nevertheless, United has consistently delayed discussions and has been challenging to provide coverage to its patients even with prior authorization. Thus, United appears to be intentionally trying to delay coverage and not pay for this new epinephrine option.
If United Healthcare governs your coverage, you are urged to contact the insurer and insist that access to neffy — the only needle-free device available — is critical to your family’s well-being and should be added to its formulary and coverage ASAP.
It’s important to note that today, the majority of commercially insured patients encounter coverage barriers to obtaining neffy prescribed by their healthcare providers. Some insurance providers either deny coverage or require prior authorization, often necessitating trial and demonstrating “failure” of “preferred” generic products. Healthcare providers have expressed frustration with interpreting “failure” when submitting prior authorization paperwork to insurance carriers to obtain neffy as an alternative to injection products for their patients.
Helpful information regarding coverage for neffy
neffyConnect is their support program that provides access support, financial assistance (if eligible), and education for patients with a prescription. Get helpful resources and tools delivered to your email by registering with neffyconnect. neffy is also available through online pharmacy BlinkRx, which provides support with insurance inquiries, finds the best pricing options based on eligibility, and offers free at-home delivery. BlinkRx also sends timely refill reminders, helping families stay on top of their allergy management.
Retail Pharmacies: neffy is available through most retail pharmacies nationwide. As a new item, the product may not be in the pharmacy’s inventory on a daily basis. However, neffy can be located by the pharmacist in their wholesaler catalog, then ordered for next-day delivery. The pharmacy will generally order neffy when the prescription is adjudicated successfully and they are ready to dispense.
$25 Co-Pay Program: Eligible patients with commercial insurance may reduce their cost to as low as $25 with their co-pay savings card. This option can be found in the Savings & Support section of www.neffy.com, where families can also download the card for easy access. The co-pay savings card will be automatically applied if ordering through BlinkRx.
$199 Cash Price: For those who are uninsured, underinsured, or simply looking to purchase neffy ASAP, BlinkRx and GoodRx offer a cash price of $199 for two single-use devices.
The ACAAI website provides a customizable Prior Authorization Letter Generator for neffy to assist healthcare providers and patients in appealing for insurance coverage. This tool allows users to input specific details such as patient information, insurance company details, prescriber information, and diagnosis codes related to allergies or anaphylaxis. Once completed, users can download a ready-to-use letter template. For families managing severe allergies, this letter generator can help streamline the appeals process, making it easier to advocate for necessary coverage of neffy. More information can be found on the ACAAI website.
Guidance for Writing Prescriptions: For physicians who may be having difficulty writing prescriptions for neffy, the following information may be useful. For additional resources, please visit https://www.neffypro.com/#programs-and-resources
neffy (epinephrine nasal spray) 2mg/0.1mL
NDC: 82580-0020-02
Dispense as Written
Qty: 2 cartons (4 devices)
Patient Assistance Program: Their goal is to offer worry-free support that ensures everyone can access neffy at an affordable cost. For eligible US residents who are uninsured or underinsured, meet certain eligibility criteria, and have exhausted all other options, the ARS Pharmaceuticals Patient Assistance Program (PAP) will provide neffy at no cost.
