EpiPen Costs and Alternatives: What are your Best Options?
Medically reviewed on Mar 16, 2018 by L. Anderson, PharmD.
Concerns about pharmaceutical drug pricing -- some might even call it price gouging -- have been rampant in the United States. Recent pricing concerns have even made it as far as congressional hearings in Washington, D.C. Patients, doctors, politicians, and pharmaceutical industry are all debating on how -- and if -- to lower drug costs.
One popular controversy swirls around EpiPen (epinephrine), an injectable medication required by people who have severe, life-threatening allergies (anaphylaxis). Bee stings, medications, peanut butter, shellfish, and latex are just a few of the allergens (or allergy triggers) that can lead to anaphylaxis (pronounced "ana-fi-LAX-is"). Keeping this medication on hand isn’t an option as the allergic reaction can be fatal. However, cheaper options are now available after much concern about the price of this life-saving drug.
What Is An EpiPen Used For?
Epinephrine (EpiPen, EpiPen Jr, Adrenaclick, Auvi-Q, Symjepi, or generic epinephrine auto-injector) is the first-line treatment for anaphylaxis. 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 Mylan. 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 to prevent an anaphylactic reaction. However, if exposure does occurs, an auto-injectable epinephrine like EpiPen is used to help prevent the severe allergy 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 is an allergic medical emergency and results in:
- 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 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 what epinephrine product is covered.
- See Table 1 for more EpiPen alternatives
Mylan 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 from $150 to over $300 at some pharmacies; again it’s worth checking around if you are a cash customer. Some patients may be eligible for EpiPen or authorized generic discounts or co-pay coupon cards through Mylan and the EpiPen website.
What is An Authorized Generic?
The only difference between an authorized generic and its brand name alternative is the name on the label. 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”. Manufacturers are allowed to sell an authorized generic of their brand name product already approved by the FDA.
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. Concerns existed that the drug was not priced fairly for patients with a life-threatening allergy. Over the last decade, the EpiPen cost had soared from roughly $100 to over $600 per two-injector package.
Members of Congress also raised the point that the EpiPen, which is used by many children on the government assistance program Medicaid, was unfairly overpriced and that taxpayers were “picking up the tab” for the drug.
Before the availability of cheaper generics for EpiPen, Mylan controlled 90% of the market and faced little competition for EpiPen. According to The New York Times, Mylan also blocked competition by requiring schools that obtained discounted EpiPens to sign a contract that forbid them from buying injectors from other companies.
Mylan defended itself saying that EpiPen improvements had led to price increases, that insurance often covers the devices, and that the company provides discounts to those who qualify. However, 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 Coupons and Savings Cards
For patients who quality, financial assistance from Mylan may be available for the EpiPen 2-Pak and EpiPen Jr. 2-Pak. The EpiPen Savings Card, found on Mylan's website, 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 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
Mylan also is offering a savings card for the authorized generic for eligible patients with commercial health insurance. The card provides up to $25 off the out-of-pocket cost on the authorized generic.
EpiPen Patient Assistance
Mylan 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 the program by emailing email@example.com or calling Mylan Customer Relations at 1-800-395-3376 to speak with a representative.
Is There a Generic for EpiPen?
Yes, there are now more affordable alternatives to the EpiPen brand name product, including the authorized generic from Mylan for EpiPen and EpiPen Jr. The price of brand name EpiPen is often out of reach for many patients. However, Mylan now offers the authorized generic for Epipen for roughly $150 to $350 for a two-pack, depending upon the pharmacy.
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 CVS Pharmacy for $109.99 for a two-pack. Other pharmacies also offer the authorized generic for Adrenaclick, but double check the price, as it may be different than the price at CVS.
- See Table 1 for all currently available brand and generic epinephrine auto-injectors.
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, and a smaller size. It also contains an automatic retractable needle system. This serves as a safety feature and retracts the needle back into the device within seconds.
Auvi-Q was recalled from the market in 2015 due to concern that the device was delivering incorrect doses. However, after addressing these concerns, the manufacturer Kaleo re-introduced Auvi-Q to the U.S. market in 2017. The cash cost is enormous for Auvi-Q -- roughly $5,000 for two injectors -- but Kaleo has posted a $0 out-of-pocket costs for commercially insured patients on the Auvi-Q website (through the direct delivery service), and other discounts may be available as well.
According to the Auvi-Q Affordability Program:
- More than 200 million Americans with commercial insurance, including those with high-deductible plans, will be able to obtain Auvi-Q for $0 out-of-pocket.
- Auvi-Q will be available free of charge to patients with a household income of less than $100,000 who do not have government or commercial insurance.
- Medicaid patients may be able to obtain Auvi-Q for $0 out-of-pocket through the kaléo Cares Patient Assistance Program.
In 2018, a 0.1 mg dose of Auvi-Q will be marketed to deliver a dose of epinephrine appropriate for infants and small children weighing 16.5 to 33 pounds, and with a shorter needle.
What is Symjepi?
In June, 2017 the FDA cleared Symjepi (epinephrine), a new, single-dose, prefilled syringe of epinephrine used for the emergency treatment of allergic reactions (Type I) including anaphylaxis, a severe and potentially life-threatening type of allergy.
The product provides two, single dose syringes of epinephrine which is considered the drug of choice in acute anaphylactic reactions involving insect stings, food allergies (such as nuts or shellfish), or medications, among others.
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 needed is first inserted in the thigh, then the top plunger is depressed until it clicks to release the medicine. Symjepi is not yet available in pharmacies and the price is not known.
How Long Are EpiPens Good For?
The question often comes up: “How long do EpiPens last before they expire?” 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 auto-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.
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.
Can You Buy an EpiPen Over-the-Counter?
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 care 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.
Consumers should be wary of online purchases of EpiPen over the Internet, even those that claim to be Canadian pharmacies, as the product could be tainted 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.
According to Carmen Catizone, the executive director of the National Association of Boards of Pharmacy, many online pharmacies claiming to be Canadian are not. They are fraud websites selling unapproved drugs that are counterfeit or poorly made.
Table 1: EpiPen Costs 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 cash price (two auto-injectors)||Possibly save $300 on EpiPen or EpiPen Jr from Mylan|
|Authorized Generic for EpiPen and EpiPen Jr. (epinephrine auto-injector) from Mylan||0.15 mg; 0.3 mg||About $150 to $300; possibly higher priced at other pharmacies; call ahead||Coupon may be needed|
|Adrenaclick||0.15 mg; 0.3 mg||Roughly $450 to $500; price varies among pharmacies||Drugs.com Discount Card|
|Authorized Generic for Adrenaclick (epinephrine auto-injector) from Impax||0.15 mg; 0.3 mg||$109.99 at CVS Pharmacy; higher at other pharmacies||No coupon needed; possibly save $50 from Impax at epinephrineautoinject.com|
|Auvi-Q||0.1 mg (coming in 2018), 0.15 mg; 0.3 mg||$0 copay for insured patients and for families with income of less than $100,000/year without insurance. One prescription includes two auto-injectors. Has voice instructions.||AUVI-Q AffordAbility Patient Assistance|
|Symjepi||0.3 mg||Price not yet available; launch date unknown. One prescription includes two syringes.||See manufacturer’s website for patient assistance.|
Note: Prices may vary depending on the pharmacy you visit or manufacturer price adjustments
- Slideshow: Understanding Anaphylaxis: Don't Let It Shock You
- Drugs.com Epinephrine Prices, Coupons, and Patient Assistance Program
- Learn More About Anaphylaxis and Treatments
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