The Virginia Department of Health (VDH) and the Virginia Department of Education (DOE) have implemented a policy so that every K-12 public school can procure undesignated stock of epinephrine auto-injectors, albuterol inhalers, and valved holding chambers (spacers). This policy is also available to private schools, though the requirements and acquisition process may differ. Private schools are encouraged to consult with their accrediting agency for guidance.
For more information about ordering naloxone, please visit this site.
To obtain Epinephrine and Albuterol, schools are to complete Epinephrine/Albuterol training, once annually. The Virginia Department of Education (VDOE) has provided guidelines for the required annual Epinephrine and Albuterol training for schools, as outlined below.
- Schools may use the School Nursing Checklist to help prepare them in meeting their training and planning needs for the school year.
- The School Health Guidance, Resources, & Required Training resource provides schools may use to implement and provide the necessary training for staff.
- Although VDOE has established training and resources for schools to use, it is not mandatory that schools use the resources from VDOE. Schools may use their own locally developed training and resources to meet the training requirements.
Standing Orders
The State Health Commissioner has issued a Statewide Standing Order for Epinephrine in School Settings for K-12 schools to use, which authorizes schools to possess and administer epinephrine to a student experiencing a life-threatening allergic reaction.
Schools may obtain undesignated stock of epinephrine through the EpiPen 4 Schools Program, through VDH Division of Pharmacy Services or through a local pharmacy.
To receive albuterol, all K-12 schools must request a standing order. Please see example here: Albuterol Standing Order Example.
- Public Schools (required to possess undesignated stock albuterol): Unless a public school has a contracted physician to sign the order locally, requests for a standing order should be submitted to VDH via the online form.
- Private Schools (optional to possess undesignated stock albuterol): Private schools should use a contracted physician to sign the order.
Schools may obtain undesignated stock of albuterol through VDH Division of Pharmacy Services or through a local pharmacy.
Ordering Resources
- The EpiPen 4 Schools Program is a program administered by Mylan, the manufacturer that makes EPIPEN. Through this program, schools may apply for up to 4 EPIPEN autoinjectors.
Please note: VDH does not provide technical support for this program. School administrators should work directly with the EpiPen 4 Schools program for questions regarding application or order status.
To obtain EPIPENs from the EpiPen 4 Schools program, schools need to:
- Fill out the Free Certification Form.
- Obtain a copy of the Virginia Statewide Standing Order for Epinephrine found here.
- Create an account and place the order online.
- Schools can fax the free certification form with the standing order to 973-845-7600 or if they create an order online, they can attach the standing order to the online submission.
Please note: Shipping delays may occur. If a school has expired stock or is in dire need of medication, schools should consider alternative access points for epinephrine, such as VDH Pharmacy Services or a local pharmacy to obtain the necessary items.
Licensed pharmacies in Virginia are authorized to sell undesignated stock of medications as long as it does not exceed 5% of gross annual prescription sales, pursuant to Virginia Board of Pharmacy regulations. Selling undesignated stock of medication is not common in standard community pharmacies and some corporate chain pharmacies may have policies to not sell undesignated stock of medications. If trying to obtain epinephrine or albuterol from a local pharmacy, below are key points to understand when discussing with the pharmacist:
- Licensed pharmacies have the authority to sell undesignated stock of medication as long as it does not exceed 5% of gross annual prescription sales.
- The standing order for epinephrine or albuterol does not authorize pharmacists to dispense epinephrine or albuterol to an individual. The standing order authorizes school staff to possess and administer epinephrine or albuterol to a student in the event of emergency.
- A standing order is not needed for the pharmacy to sell undesignated stock of epinephrine or albuterol. The reason for presenting the standing order at the pharmacy is to indicate that the requestor is authorized to possess and administer the requested medication.
- A pharmacist may choose to not sell undesignated stock medication for a variety of reasons. It is at the discretion of the pharmacist whether they will sell undesignated stock medication.
If a pharmacy is unable or unwilling to sell undesignated stock of medication, schools should seek the medications through either the EpiPen 4 Schools Program or through VDH Division of Pharmacy Services.
Please note that any school that wishes to order epinephrine from VDH will need an Agreement with VDH. To view an example of the Agreement, please click here.
Prices for Epinephrine are listed below:
Public and Private Schools:
- Auvi-Q 0.1mg (epinephrine) auto injector - $290 per item
- Epinephrine 0.15mg auto injector - $300 per item
- Epinephrine 0.3mg auto injector - $315 per item
Prices are inclusive of shipping costs. Pricing may be updated if VDH pricing changes. Public schools are eligible to receive reduced medication prices as a government entity. Private schools are now eligible to receive the same reduced medication prices as public schools.
For more information about obtaining epinephrine, please view our frequently asked questions document.
Please note that any school that wishes to order Albuterol from VDH will need both the Agreement with VDH and a current signed Standing Order.
Albuterol and Medical Supplies Pricing:
Public Schools:
- Albuterol inhaler (90 mcg, 6.7 gm inhaler, 200 puffs per inhaler) - $25 per item
Private Schools:
- Albuterol inhaler (90 mcg, 6.7 gm inhaler, 200 puffs per inhaler) - $54 per item
Medical Supply Prices for Public and Private Schools:
- LiteAir Disposable Dual Valved Holding Chamber - $7.50
- Reusable Dual Valved Holding Chamber Without Mask - $17.50
- Reusable Antistatic Valved Holding Chamber/spacer With Small Mask Aerochamber - $30
- Reusable Antistatic Valved Holding Chamber/spacer With Medium Mask Aerochamber - $30
- Reusable Antistatic Valved Holding Chamber/spacer With Large Mask Aerochamber - $30
Prices are inclusive of shipping costs. Pricing may be updated if VDH pricing changes. Public schools are eligible to receive reduced medication prices as a government entity. Private schools are not eligible to receive reduced medication prices.
For more information about ordering albuterol, please view our frequently asked questions document.
Epinephrine or Albuterol Order Process
Step 1: Apply
Use this form to APPLY if it is the first time your organization has requested Epinephrine or Albuterol, if your organization’s MOU with VDH has expired, or if your organization needs a current signed Standing Order for Albuterol. Once all signatures are obtained and the MOU and/or standing order is executed, the organization is responsible for ensuring the MOU and standing order is updated before the expiration date.
For questions regarding the application process, please contact pharmacyvisions@vdh.virginia.gov.
Step 2: Order
Use this form to ORDER after your organization has a fully executed MOU with the Virginia Department of Health and/or current signed Standing Order for Albuterol for provision of Epinephrine and/or Albuterol.
If you are unsure whether your organization has an executed MOU, if an MOU is still active, or if your organization has a current Standing Order for Albuterol, please contact pharmacyvisions@vdh.virginia.gov.
Step 3: Return
Please use this form to RETURN expired or unused epinephrine or Albuterol that was provided by the Virginia Department of Health