Does Medicare Cover EpiPen?

Epinephrine auto-injectors, which may be sold under the brand name EpiPen, are used to treat life-threatening allergic reactions when medical care isn’t immediately available. These devices, which severely allergic individuals may carry with them regularly, are usually covered under Medicare Part D or Medicare Advantage policies that include bundled prescription drug plans. However, coverage may vary depending on the specific plan’s formulary. Learn more about Medicare coverage of EpiPens, including how to determine the reimbursement rate under your individual policy.

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Does Medicare Cover EpiPen?

Most Medicare prescription drug plans, including those bundled with Medicare Advantage policies, cover either EpiPen or a generic alternative. Medicare Part C and D drug plans typically provide coverage for a wide range of name brand and generic prescription medications. However, because these plans are offered by private companies, each plan maintains a unique formulary containing a list of covered pharmaceuticals. Consequently, coverage of EpiPen, including costs and quantity limits, may vary by plan.

Medicare prescription drug plans generally cover at least two medications in all commonly prescribed categories, so if EpiPen is not covered under your policy, a similar drug should be. If EpiPen isn’t covered under your Part C or D plan, you may also request a formulary exception through your carrier, but approval isn't guaranteed.

When purchasing prescription medications using Medicare Part C or D coverage, some beneficiaries may be responsible for meeting deductibles or paying a coinsurance.

What Is EpiPen?

EpiPen, which is manufactured by Pfizer, is a single-dose automatic injection device that dispenses a fixed amount of epinephrine to treat life-threatening allergic emergencies known as anaphylaxis. The device is designed to be portable, so it may be carried in a purse or clipped to a belt, letting a severely allergic individual keep it handy at all times. 

This potentially life-saving device is available by prescription only. A separate training device, known as a trainer, may be purchased so users or caregivers can practice administering injections prior to an emergency situation.

How Is EpiPen Used?

Doctors may prescribe EpiPen for individuals who experience severe allergic reactions to latex, certain medications, insect bites or stings or specific food items such as peanuts. These individuals may carry an EpiPen for use in an anaphylactic emergency.

If anaphylaxis occurs, EpiPen should be administered according to the physician’s or pharmacist’s instructions. An EpiPen injection may be self-administered or can be given by another person. To administer the injection, remove the safety cap and press the tip of the device against a person’s outer thigh until the EpiPen clicks, which indicates that the medication has been injected. The device is capable of penetrating clothing.

If symptoms persist, a second EpiPen may be required. The individual experiencing anaphylaxis should seek medical assistance as soon as possible.

What Are the Symptoms of Anaphylaxis?

Anaphylaxis is a severe, often life-threatening reaction to an allergen, which can occur within minutes of exposure. Common symptoms of anaphylaxis include:

• Hives
• Swelling
• Hoarseness
• Clammy skin
• Difficulty breathing
• Dizziness or fainting
• Abdominal pain
• Nausea or vomiting
• Rapid heart rate
• Low blood pressure
• Loss of consciousness

An individual having an anaphylactic reaction may also experience confusion, generalized anxiety or feelings of doom.

How Much Does EpiPen Cost Without Insurance?

Without insurance, a two-pack of EpiPens may cost between $700 and $800.  Coupons which lower the out-of-pocket cost may be available to some consumers.

Generic alternatives may cost as much as two thirds less than the name-brand device, with a two-pack generic averaging just less than $400 in the United States in 2019. The cost of other injectable epinephrine alternatives, such as Adrenaclick and AUVI-Q, may vary widely.

Can Seniors Get Help Paying for a Medicare Prescription Drug Plan?

Medicare's Extra Help program is designed to help low-income seniors pay for a prescription drug plan. Through Extra Help, individuals who are enrolled in a Part D plan may qualify for assistance paying for monthly premiums, annual deductibles and copays. To qualify for the program, applicants must be enrolled in Medicare Part A and/or B and meet the program's income requirements. Individuals who receive SSI or who are dual Medicare/Medicaid eligible should not apply.

Are There Any Savings Programs for EpiPen?

Yes, the EpiPen Savings Card can save consumers up to $300 for an EpiPen two-pack refill. The card, which is reusable up to six times, may be printed or stored on a smartphone and presented to the pharmacy at the time of purchase. This savings may be used in conjunction with commercial insurance but not Medicare plans.

A similar savings card is available to defray the cost of the authorized generic injector, saving consumers up to $25 for each injection. The card is reusable up to three times but may not be used alongside Medicare prescription drug plans.

The Viatris EpiPen Patient Assistance Program is also available to help consumers pay for EpiPen. To qualify for the program, individuals must meet strict income requirements and may not receive medical insurance through a federal or state program such as Medicare or Medicaid.

Can Medigap Help Defray the Cost of EpiPen?

Medigap plans are private insurance policies designed to supplement Original Medicare. Depending on the carrier and individual plan, these policies may help beneficiaries cover the cost of deductibles, coinsurance and copays for items that are covered under Medicare. Some Medigap plans pay up to 100% of these Medicare-related out-of-pocket expenses.

Are There Safe Alternatives to EpiPen?

There are two main name-brand alternatives to EpiPen: AUVI-Q and Adrenaclick.

AUVI-Q

AUVI-Q, which must be purchased through a mail-order pharmacy, is more expensive than EpiPen. However, it’s generally free through commercial insurance, and it comes with a trainer.

Adrenaclick

Adrenaclick tends to cost less than EpiPen or AUVI-Q, but new users must purchase a trainer separately. CVS pharmacy sells a more affordable, generic version as well.

Because different devices may dispense medication differently, you should be sure you or a caregiver understand how to operate the device you're carrying prior to an emergency.