EpiPen Costs and Alternatives: What Are Your Best Options?
Concerns about pharmaceutical drug pricing have been rampant in the United States. This is especially worrisome when it affects medicines that have few or no other alternatives.
For example, take the EpiPen (epinephrine), an injectable medication required by people who have severe, life-threatening allergies (anaphylaxis). Keeping this medication on hand is the only option as the allergic reaction can be quickly fatal.
What causes a life-threatening allergy? Examples include:
- Stings (bees, yellow jackers, wasps, hornets, fire ants)
- Nuts, peanut butter, other nut butters
- Wheat, soy, sesame and milk
- Exercise (less common)
These are just a few of the allergens (or allergy triggers) that can lead to anaphylaxis.
What Is An EpiPen Used For?
Epinephrine (EpiPen, EpiPen Jr, Adrenaclick, Auvi-Q, Symjepi, or generic versions of the epinephrine autoinjector) is the first-line treatment for anaphylaxis. An autoinjector is a self-injectable device.
- Epinephrine is the man-made version of adrenaline, a natural hormone substance the body releases in response to stress, and it is classified as a catecholamine.
- Without the immediate administration of epinephrine, those who are having a severe allergic reaction can go into anaphylactic shock, which can be fatal.
EpiPen, also known by its generic name as epinephrine, is a prescription-only brand name medication made by Viatris. EpiPen was initially approved in 1989, but its active ingredient, epinephrine was first synthesized in 1906.
It’s always best, when possible, to avoid the allergy trigger that causes your severe allergic reaction. However, if exposure does occurs, an auto-injectable epinephrine like EpiPen is used to help prevent anaphylaxis and should be given quickly.
Several epinephrine products come in an auto-injector pen that can be used by the patient, parent, teacher, school nurse, or any bystander. The injection is given in the thigh, and can even be given through clothing.
What is Anaphylaxis?
Anaphylaxis (pronounced "ana-fi-LAX-is") is an medical emergency due to a severe allergy and may result in symptoms such as:
- Hives and swelling
- Breathing difficulty or swallowing problems due to throat swelling
- Drop in blood pressure (hypotension), fainting
- Chest tightness
- Nausea, vomiting, stomach cramps
- Pale or red skin color
How Much Does an EpiPen Cost?
One brand name EpiPen or EpiPen Jr. package (which contains 2 auto-injectors) will cost roughly $650 to $700 if you are paying cash, although pharmacy coupons or manufacturers discounts may lower the price. It may be worthwhile to check with your insurance company before you get your prescription to find out which epinephrine product is covered.
- See Table 1 below for available EpiPen brands, authorized generics and generic products on the U.S. market.
- Learn more about Epipen and epinephrine pricing here.
Viatris has released an authorized generic version of the EpiPen, which is the same drug and device without the EpiPen brand name. Using online coupons, consumers can get the authorized generic epinephrine auto-injector two-pack ranging from $150 to close to $400 at some pharmacies; again it’s worth checking around if you are a cash customer. Prices can vary based on location and manufacturer.
Some patients may be eligible for EpiPen patient assistance or authorized generic discounts or co-pay coupon cards through Viatris (formerly Mylan) website. If you are paying cash, look for an online coupon which might save you hundreds
Is There a Generic for EpiPen?
Yes, cheaper options are now available for this life-saving drug.
- In fact, the first generic version of EpiPen and EpiPen Jr (epinephrine) auto-injector, from Teva Pharmaceuticals, was approved in August 2018.
- The generic epinephrine auto-injector comes in 0.3 mg and 0.15 mg strengths. Patients greater than or equal to 30 kg (66 lbs) use the 0.3 mg strength and patients 15 to 30 kg (33 lbs to 66 lbs) use the 0.15 mg strength.
- It's the same drug and the same autoinjector device you'd find with the Epipen, and it's used exactly the same way.
There are other more affordable alternatives to the EpiPen brand name product, including the authorized generic for EpiPen and EpiPen Jr. which can be purchased for roughly $200 for a two-pack, depending upon the pharmacy and if you use an online coupon.
Another option is a product known as Adrenaclick, which is an epinephrine auto-injector that is similar to EpiPen. Adrenaclick is expensive, running close to $500 per two-pack. However, Adrenaclick also has an authorized generic epinephrine auto-injector and it can be obtained from some pharmacies for about $110 for a two-pack.
Other pharmacies also offer the authorized generic for Adrenaclick, but double check the cash price, as it may be more expensive. The FDA issued an Alert in June 2020 about malfunctions with the Adrenaclick device, so be sure to check any products you have on hand.
What is An Authorized Generic?
The only difference between an authorized generic and its brand name alternative is the name on the label, according to the FDA.
- For example, the authorized generic for EpiPen is the same drug (therapeutically equivalent) and the same device; however, the packaging states “epinephrine” on the label instead of “EpiPen”.
- An authorized generic is made by the same manufacturer under their existing New Drug Application (NDA) already approved by the FDA. The same manufacturing plant is also used.
- Manufacturers are allowed to sell an authorized generic of their brand name product, and may sell it at a lower price, although it may not be as affordable as true generic.
Why is EpiPen So Expensive?
In August 2016 two U.S. senators questioned why there had been such a massive EpiPen price increase by Mylan, the manufacturer of EpiPen at the time. Concerns existed that the drug was not priced fairly for patients with a life-threatening allergy without other options. Over the last decade, the EpiPen cost had soared from roughly $100 to over $600 per two-injector package
In response to an outcry, in December 2016 Mylan launched the first authorized generic for EpiPen at a 50% discount to the brand name product. However, since the launch of Mylan’s authorized generic for EpiPen, even more affordable generic epinephrine auto-injectors have become available.
EpiPen Patient Assistance & Coupons
EpiPen and epinephrine autoinjector Savings Card
For patients who qualify, financial assistance may be available for the EpiPen 2-Pak and EpiPen Jr. 2-Pak. The EpiPen Savings Card can be used to reduce the amount of out-of-pocket expenses for the patient. The Savings Card is not considered health insurance. Present the Savings Card, valid prescription, and insurance card to your pharmacy.
The following are the requirement to be eligible to use the EpiPen Savings Card:
- 18 years of age or older, resident of the U.S.
- Only valid for patients with commercial insurance
- Not valid for patients without insurance
- Not valid for patients who are covered by any state or federally funded healthcare program
- Not valid if patient is Medicare eligible and enrolled in an employer-sponsored health plan or prescription benefit program for retirees
- Not valid if the patient’s insurance plan is paying the entire cost of this prescription
- This program may not be valid in some states.
This offer that can provide you up to $300 savings for each EpiPen 2-Pak carton per prescription refill (a maximum of six 2-pack cartons per year).
Viatris is offering a savings card for the authorized generic epinephrine autoinjector for eligible patients with commercial health insurance. The card provides up to $25 off the out-of-pocket cost on the authorized generic and can be used for a total of three epinephrine Injection cartons (six total auto-injectors per calendar year).
EpiPen Patient Assistance
Viatris also offers an EpiPen patient assistance program for those who are eligible. To enroll, patients must complete the patient assistance program form with their physician.
Patients can obtain additional information on savings programs by emailing customer service or calling Viatris Customer Relations at 1-800-796-9526 to speak with a representative.
What is Auvi-Q?
Auvi-Q is a brand name epinephrine auto-injector with unique features such as voice instructions that help guide a user with step-by-step instructions through the epinephrine delivery process, a smaller size, and an automatic retractable needle system. This serves as a safety feature and retracts the needle back into the device within seconds.
Auvi-Q is available as 0.3 mg dose for patients greater than or equal to 30 kg (66 lbs). Two lower doses of Auvi-Q (0.1 mg and 0.15 mg) are also approved to deliver a dose of epinephrine appropriate for infants and small children.
The cash price for Auvi-Q is significant -- roughly $600 for two injectors using coupons -- but Kaleo has posted a $25 or less cost for commercially insured patients on the Auvi-Q website (through the direct delivery service or pick up at Walgreens). Offer applies to two cartons of Auvi-Q per dose, per patient each calendar year. Call 844-357-3968 for offer eligibility questions. Your out-of-pocket costs may vary.
Through the Kaleo Patient Assistance Program, eligible patients who do not have commercial insurance and who are experiencing financial difficulties may be able to receive Auvi-Q at no cost. Kaleo provides a form for enrollment on their website that both you and your healthcare provider will complete. For assistance with any questions, call 502-213-7601.
What is Symjepi?
In June, 2017 the FDA cleared Symjepi (epinephrine), a new, single-dose, prefilled syringe of epinephrine also used for the emergency treatment of anaphylaxis. The product provides two, single dose syringes of epinephrine (not an auto-injector).
The manufacturer reports that Symjepi is lower cost, a smaller size and has a more user-friendly design than EpiPen.
- Unlike most auto-injectors, Symjepi's needle is not spring-loaded; instead, the needle is first inserted in the thigh, then the top plunger is depressed until it clicks to release the medicine.
- The more simple design may help to keep prices within reason.
- The cost for Symjepi is roughly $270 for 2 syringes using an online discount coupon.
How Long Do EpiPens Last?
EpiPens can remain unused for long periods of time, so many patients wonder how long an EpiPen can last before it expires. Expiration dates for the auto-injectors come up quickly, usually in one year, meaning regular - and affordable - replacement for this life-saving medication is a must. Patients usually need multiple EpiPen packs to keep at home, work, or school in case of exposure to the allergen.
Always check your epinephrine injector at the counter when you pick it up from the pharmacy and make sure it has at least one year before expiring. If not, speak to your pharmacist about getting a different injector with a longer expiration date.
Most schools in the U.S. now either require or allow the school to have access to epinephrine for those who do not have their own supply. Keep a supply of epinephrine at home, work AND at school, and remember to refill your prescription before your epinephrine auto-injector has expired.
Is EpiPen Available Without a Prescription? (OTC)
In the U.S., you cannot buy EpiPen unless you have a prescription from your doctor. Some schools do stock the product for emergency use, but use in that setting would still be under the direction of a health care provider.
Other countries, such as Canada, have epinephrine auto-injectors available without a prescription at the pharmacy.
How Much Does an EpiPen Cost in Canada?
If you happen to be in Canada, buying an EpiPen from an established pharmacy will cost you around $100 to $150, and it is available without a prescription. Canada, like the U.S., does have strict laws overseeing the safety of prescription medications. However, bringing an epinephrine auto-injector over the border from Canada into the U.S. may be questioned and your medication may be confiscated by customs officials at the border. Plus many epinephrine products in the U.S. can now be found for roughly $110 or so.
Consumers should be wary of online purchases of EpiPen over the Internet, even those that claim to be Canadian pharmacies. The product might be contaminated or a fraud containing no medication at all. It’s not worth it to purchase a life-saving drug when you can’t be sure of it’s authenticity or safety.
Table 1: Epinephrine Prices, Savings and Coupons - Epipen and Alternatives
|Product||Strengths Available||Price Estimate (2-pack)||Ways to Save|
|EpiPen; EpiPen Jr. (epinephrine auto-injector)||0.15 mg; 0.3 mg||About $650-$700 cash price (two auto-injectors).||Possibly save $300 on EpiPen or EpiPen Jr. Contact Viatris for brand name savings.|
|Authorized generic for EpiPen and EpiPen Jr. (epinephrine auto-injector).||0.15 mg; 0.3 mg||About $185; possibly higher priced at some pharmacies; call ahead.||Coupon may be needed. Contact Viatris for authorized generic savings.|
|epinephrine (generic for EpiPen, EpiPen Jr.) from Teva Pharma||0.15 mg; 0.3 mg||$95 to upwards of $300 for a 2-pack using cost-saving coupons. Prices vary among pharmacies.||Expected to be low cost but coupon may still be beneficial.|
|Adrenaclick||0.15 mg; 0.3 mg||Roughly $500; price varies among pharmacies.||Drugs.com Discount Card. Further savings may be available from Amedra Pharmaceuticals|
|Authorized generic for Adrenaclick (epinephrine auto-injector)||0.15 mg; 0.3 mg||$110 cash price at some US-based pharmacies; may be higher at other pharmacies; call ahead.||$0 cost (if commercially insured) or $10 savings from Amneal Pharmaceuticals|
|Auvi-Q||0.1 mg, 0.15 mg, and 0.3 mg||
Device offers voice instructions.
Using an online coupon, cash price is roughly $600 for two injectors.
|$25 or less cost for commercially insured patients on the Auvi-Q website (through the direct delivery service or pick up at Walgreens). $0 cost via the Kaleo Patient Assistance Program, if eligible.|
|Symjepi||0.15 mg, 0.3 mg||Cash price is about $270 for 2 syringes; one prescription includes two syringes.||
Commercially insured and covered patients will pay $0 for each Symjepi prescription filled.
Patients without insurance coverage can receive up to $100 off each prescription. Annual maximum benefit is $1000. Contact US WorldMeds for inforamation.
Note: Prices may vary depending on the pharmacy you visit, insurance or manufacturer price adjustments. Look for online discount coupons or discount cards if paying cash out-of-pocket. Generic epinephrine is covered by most insurers, including Medicare, Medicaid and commercial insurance plans.
- Slideshow: Understanding Anaphylaxis: Don't Let It Shock You
- Drugs.com Epinephrine Prices, Coupons, and Patient Assistance Program
- Learn More About Anaphylaxis and Treatments
- Allergies, Cough/Cold Medications and Alcohol Interactions
- Back to School Basics: 5 Common Health Questions From Parents
- Benadryl Dosage Charts for Infants and Children
- Claritin Dosage Charts for Infants and Children
- Low Salicylate Diet
- Zyrtec Dosage Charts for Infants and Children
Symptoms and treatments
Medicine.com guides (external)
- FDA Approves Kaléo’s Auvi-Q (Epinephrine Injection, USP) 0.1 mg Auto-Injector for Life-Threatening Allergic Reactions in Infants and Small Children. Drugs.com. Accessed Apr 29, 2022. https://www.drugs.com/history/auvi-q.html
- Sneader W. The discovery and synthesis of epinephrine. Drug News Perspect. 2001;14(8):491-494. doi:10.1358/dnp.2001.14.8.858417 Accessed Apr 29, 2022.
- Mylan.com. Mylan's Authorized Generic to EpiPen. (epinephrine injection, USP) Auto-injector. Accessed Apr 29, 2022.
- Mukherjee S. Mylan’s CEO Tells Congress the EpiPen Price Hike Was ‘Fair’. Fortune.com. Sept. 21, 2016 Accessed August 19, 2018.
- Editorial. The EpiPen Outrage Continues. Sept. 21, 2016. New York Times. Accessed Apr 29, 2022 at https://www.nytimes.com/2016/09/22/opinion/the-epipen-outrage-continues.html
- Epinephrine injection, USP auto-injector. Amedra Pharmaceuticals. Horsham, PA. Accessed Apr 29, 2022. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020800s035lbl.pdf
- Kaléo Announces U.S. Availability and Pricing to Patients of Auvi-Q (Epinephrine Injection, USP) Auto-Injector, For Life-Threatening Allergic Reactions. Jan 19, 2017. Accessed Apr 29, 2022 at https://kaleo.com/kaleo-announces-u-s-availability-and-pricing-to-patients-of-auvi-q-epinephrine-injection-usp-auto-injector-for-life-threatening-allergic-reactions/
- Carr T. Don't Order EpiPens From Canada. Consumer Reports.org. Accessed August 7, 2020 at https://www.consumerreports.org/drugs/dont-order-epipens-from-canada/
- Americans turn to Canada for cheaper EpiPens. The Star.com Accessed Apr 29, 2022 at https://www.thestar.com/news/canada/2016/08/25/americans-turn-to-canada-for-cheaper-epipens.html
- FDA Approves Symjepi. Drugs.com. Accessed Apr 29, 2022 at https://www.drugs.com/history/symjepi.html
- Auvi-Q (epinephrine) Product Labeling. Kaleo Pharmaceuticals. Richmond, VA. Accessed Apr 29, 2022 at https://www.auvi-q.com/
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.