Does Insurance Cover EpiPens?

Most health insurance plans cover epinephrine autoinjectors like EpiPens whether you have coverage through a private insurance company or a government-funded program. Exact coverage details and your share of the out-of-pocket costs may depend on whether you get a name-brand EpiPen or a generic alternative.

Continue reading for more specific details about when health insurance covers EpiPens and how much EpiPens can cost with and without major medical coverage.

On This Page

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  Which Health Insurance Plans Cover EpiPen Autoinjectors?

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  How Much Is an EpiPen Without Insurance?

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  Are There Ways To Lower the Cost of an EpiPen Without Insurance?

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  FAQs

Which Health Insurance Plans Cover EpiPen Autoinjectors?

The vast majority of health plans cover epinephrine injections, although coverage may not always apply to EpiPen products sold by Viatris. You can read the below sections for an overview of some of the most common types of health insurance that cover EpiPens.

Private Health Plans

You can expect most private health insurance companies to cover epinephrine autoinjectors prescribed by your doctor for the treatment of severe allergic reactions since all Marketplace health plans are required to cover prescription drug benefits.^[1] However, private insurers may have the discretion to deny coverage for name-brand EpiPen and EpiPen Jr autoinjectors while still covering generic variants.^[2]

Medicare and Medicare Advantage

EpiPens are covered by 99% of Medicare prescription drug plans, though most of these plans place restrictions on the amount of epinephrine you can have filled at one time. Medicare copays for EpiPens can reach up to $166 after you meet your deductible.^[3]

Keep in mind that Medicare drug coverage isn’t included in Original Medicare but you can obtain it by purchasing a Medicare Part D plan. Prescription drug coverage is also included in many Medicare Advantage plans sold by private insurance carriers.

Medicaid and CHIP

Medicaid is a major provider of EpiPen coverage, with state-run Medicaid programs covering nearly 20% of all EpiPens prescribed in 2014. Most Medicaid members can fill their EpiPen prescriptions for free with no copay. Meanwhile, Children’s Health Insurance Program (CHIP) participants usually only have to pay around a $5 copay for covered drugs like EpiPens.^[4]

How Much Is an EpiPen Without Insurance?

Without health insurance coverage, you can expect to pay around $650 to $750 for a pack of two name-brand EpiPen or EpiPen Jr autoinjectors. Authorized generic versions tend to be a bit cheaper, with two-pack prices usually ranging from $300 to $500.^[5]

You may also be able to find epinephrine injectors made by different companies that are cheaper than name-brand EpiPens.

For example, most pharmacies in Los Angeles, California, sell Symjepi autoinjector two-packs for a little over $300.^[6]

How Much Are EpiPens With Insurance?

If you have insurance, the amount you have to pay for an EpiPen depends on your plan’s copayment or coinsurance requirements for prescription drugs. To determine your copay, you may need to check what tier epinephrine falls into on your plan’s formulary, which is a list of all the prescription drugs your health insurance plan covers. For example, epinephrine injectors are considered a Tier 2 drug for veterans insured by the Department of Veteran Affairs, meaning they only require an $8 copay.^[7][8]

In addition, EpiPen drug costs may be regulated by your state government. For example, the maximum legal copay for a two-pack of epinephrine autoinjectors is $60 in Colorado.^[9] You should note that EpiPens aren’t a preventive service, which means you will generally have to pay the full price for them until you hit your deductible for the year.

Are There Ways To Lower the Cost of an EpiPen Without Insurance?

There are various ways to reduce the cost of an EpiPen and save money without medical insurance. For example, you could search for coupons you can use at your local pharmacy through companies like GoodRx and SingleCare. Additionally, you can compare prices from multiple pharmacies and see if you can get a better price on a generic version of EpiPen or an epinephrine autoinjector made by a different company.

There are also savings programs offered by Viatris, the company that sells EpiPen products. For example, eligible patients can sign up for the Viatris Patient Assistance Program to receive epinephrine injections for free if they have a demonstrable financial need and don’t have a health plan that covers prescription drugs.^[10] Alternatively, if you have private health insurance, you may be eligible for an EpiPen Savings Card that allows you to get three packs of EpiPens per prescription for up to $900 below the retail price.^[11]