Committee hears bill to let schools, first responders use epinephrine nasal sprays and sublingual films

The House Committee on Health and Mental Health heard testimony Thursday on a bill that would let schools and other care settings use additional, approved epinephrine delivery systems instead of requiring auto-injectors.

Representative Terry Violet, sponsor of the measure included in the packet of bills, said the change would allow products such as epinephrine nasal sprays and (pending federal approval) sublingual films to be used in schools and by first responders. "This bill changes statute to allow for the use of additional forms of epinephrine products in addition to the auto-injector device," she said.

Supporters — including former Missouri Association of School Nurses president Linda Newman, the Missouri Nurses Association and the Missouri State Medical Association — told the committee the alternatives could be easier and less traumatic to administer than injectors, could reduce hesitation in emergency response and could expand access in rural districts that lack full-time school nurses. Newman estimated the nasal spray currently on the market costs about $199 for a two-dose supply and said an upcoming sublingual film was expected to retail around $170 per two-dose package; injector two-packs ranged widely in price, she said.

The bill would: expand the list of allowable delivery systems to include approved nasal sprays and sublingual/dissolvable films; permit students to self-administer with parental permission and a prescription; allow first responders to administer approved forms; and include training and paperwork requirements for those who will administer epinephrine. Committee members were reminded that Missouri statutory training requirements for school staff appear at statute 167.208.

Questions centered on shelf life and cost, training and liability. Representative Hayden asked whether newer products have longer shelf lives; witnesses said epinephrine’s shelf life — not the delivery device — tends to limit product longevity and that newer products are expected to have similar shelf lives, roughly in the range of about a year. On cost, witnesses said prices are likely to be comparable across formats and noted the bill includes a fund that could be used to support fire districts stocking products, though the fund must be appropriated.

Linda Newman described tele-nursing supports and training programs used in rural districts and urged that easier-to-administer options reduce hesitation in anaphylaxis response. Multiple professional associations testified in support; no formal opposition appeared in the transcript.