Does Medicare Advantage Cover EpiPen?

In this article...
  • Understand the importance of the EpiPen if you have allergies, and learn whether most Medicare and Medicare Advantage plans cover the cost of an autoinjector.

If you're severely allergic to a type of food or to the sting of a particular insect, an EpiPen is not a luxury; it's a necessity. For people with allergies, the medication dispensed from an EpiPen can mean the difference between life and death.

Because EpiPens are expensive, it's important to choose an insurance plan that covers them. Otherwise, you might get stuck paying the cost out of pocket. Fortunately, most Medicare Part D prescription drug plans and Medicare Advantage plans provide at least some level of coverage for the EpiPen.

What Is an EpiPen?

An EpiPen is a device used to inject epinephrine into the body to counteract anaphylactic shock, which is a life-threatening reaction to a foreign substance, such as food, insect venom or certain medications. When someone experiences an anaphylactic reaction, their throat may close up, preventing them from getting enough air into their lungs. They may also go into shock. The EpiPen helps open the airway and reverse the effects of the anaphylactic reaction.

The medication in an EpiPen can only be administered after the onset of anaphylaxis, and the sooner the better. It's not possible to take a preventative or maintenance dose to prevent anaphylaxis ahead of time.

Who Should Carry an EpiPen?

Only your doctor can determine if your allergy is severe enough to necessitate carrying an EpiPen. If you or your child has suffered a severe reaction, you should have a full allergy test done and consult with an allergist about your options. As a general rule, it's better to use an EpiPen out of caution and end up not really needing it than it is to need an EpiPen and not have one. An occasional dose of epinephrine is generally not harmful to the body.

How to Inject Yourself With an EpiPen

Epinephrine is injected intramuscularly, meaning through the skin and into the muscle tissue. The best places to inject it are into the buttock and the outer thigh. It's generally better to have another person administer your EpiPen injection, particularly if you're in the throes of anaphylactic shock. But given that isn't always possible, the easiest place to do a self-injection is into the outer thigh, about an inch or two down your leg from your pants pocket.

The nice thing about EpiPen is that it comes in an easy-to-use autoinjector. That means you don't have to push a syringe plunger down yourself. You simply put the pen flush against your skin where you want to inject, apply firm but not hard pressure and push the autoinjector until you feel the needle enter your muscle. It shouldn't hurt, as the needle is tiny in girth.

What Does an EpiPen Contain?

EpiPen contains pure epinephrine, a hormone secreted by the adrenal glands that narrows blood vessels and opens airways in the lungs. It can also reduce inflammation in the body, particularly in the throat and intestines. This allows it to counteract the effects of anaphylaxis when administered at high doses.

Is EpiPen Safe to Use?

EpiPen is a safe drug with few serious side effects. Because it delivers a large dose of an adrenal hormone, it may cause temporary anxiety, dizziness and restlessness. The FDA issued a warning in 2020 about a spate of EpiPens either failing to inject or injecting after a delay, but these issues appear to have been resolved.

Is There a Generic Version of EpiPen?

Yes. The FDA approved a generic epinephrine autoinjector in 2018.

Does Medicare Cover EpiPen?

Standard Medicare Part B doesn't cover EpiPen. But if you have a Medicare Part D prescription drug plan or a Medicare Advantage MA-PD plan that covers prescription drugs, there's about a 99% chance that your plan covers EpiPen. However, for a person with severe allergies, this drug is too important to leave anything to chance. Ensure you go over your plan in detail with your insurance agent to confirm it covers EpiPen or one of its generics.

How Much Does EpiPen Cost Without Insurance Coverage?

EpiPen is an expensive drug to purchase out of pocket. The average cost of one autoinjector at a standard dosage is $139.

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