- Medicare can cover your EpiPen prescription.
- Medicare Part D and many Medicare Advantage plans cover EpiPens.
- Medicare might cover only the generic form of EpiPen, epinephrine.
- Your costs will depend on your Part D or Medicare Advantage plan.
EpiPens are an emergency medical treatment that can slow serious allergic reactions and save lives.
Medicare offers coverage for EpiPen prescriptions through Part D (prescription drug) plans or Medicare Advantage plans that include prescription drug coverage.
Your costs will depend on your specific plan, with copayments that can range anywhere from $0 to $164 for the generic form (epinephrine) and up to $700 for the brand name (EpiPen).
You can get coverage for your EpiPen prescription through Medicare. But there might be some limits.
Your plan might only cover the generic, epinephrine, and not the name brand, EpiPen. Your plan could also limit the number of times it’ll cover a prescription in a year or other set period of time.
Your EpiPen coverage with Medicare will depend on which part of Medicare you’re using.
Part A (hospital insurance)
Medicare Part A covers hospital stays and other inpatient care. It generally doesn’t pay for any medications. If you’re given an EpiPen injection while you’re receiving inpatient care, however, Medicare Part A will cover it.
Part B (medical insurance)
Medicare Part B covers you for services like:
- visits to your doctor
- ambulance rides
- at-home medical equipment
- emergency room care
It generally doesn’t cover any prescriptions you take at home. But if you receive an EpiPen injection while you’re receiving care — for example, at an urgent care center — Part B will cover it.
Part C (Medicare Advantage)
Medicare Part C is also called Medicare Advantage. Medicare requires Advantage plans to cover everything that parts A and B do. Together, parts A and B are known as original Medicare.
Many plans also include Part D coverage for prescriptions, so these would cover EpiPen.
Part D (prescription coverage)
Medicare Part D offers prescription drug coverage for Medicare beneficiaries. Most Part D plans will cover EpiPen in some form.
The cost to you will depend on your plan.
Medicare supplement (Medigap)
Medicare supplement plans, known as Medigap, cover some of the out-of-pocket costs of Medicare. They don’t offer any additional coverage for prescriptions and won’t affect your coverage for EpiPen.
EpiPens can be a very expensive prescription.
In fact, according to research from the Kaiser Family Foundation, the cost of a two-pack of EpiPens rose almost 550 percent between 2007, when the average cost was $94, and 2016, when the average cost was $609.
The good news: Medicare can help you cover the cost. Your price will depend on your exact Part D or Advantage plan, but some average prices are listed below:
- EpiPen without Medicare: $660
- EpiPen with Medicare: $15 to $700
- EpiPen with coupons: $610
- Generic epinephrine without Medicare: $406
- Generic epinephrine with Medicare: $0 to $164
- Generic epinephrine with coupons: $126
While the manufacturer of EpiPen offers a savings program on EpiPens, Medicare recipients are not eligible.
These prices might seem high, but keep in mind that you don’t need to use an EpiPen every day. In fact, you might never need to use your EpiPen prescription.
So though EpiPens are expensive, even in their generic form, it’s not a cost you’ll need to budget for on a monthly basis like you would many other prescriptions.
You have some options when it’s time to fill your EpiPen prescription. One of your first steps should be to check your Medicare Part D or Medicare Advantage plan’s formulary. A formulary is a list of prescriptions that your plan covers.
The formulary will let you know what’s covered and what your cost will be. You can then check local stores and see what coupons or savings are available. You can compare the price on your plan’s formulary with the price after using coupons, then choose the more affordable option.
For example, Aetna’s SilverScript Part D plan is available to Medicare beneficiaries in several states. Members can purchase generic epinephrine for a copayment of $47. It’s unlikely you’d be able to find a pharmacy coupon that would bring your price to less than around $125.
So, if you were a SilverScript member, going through Medicare would save you the most money. But if you check your plan’s formulary and find you’d have a copayment of more than $130, you might save more money using a pharmacy coupon instead.
You can see what your price for EpiPen and any other prescriptions you take would be for local Part D or Advantage plans by using Medicare’s plan finder tool.
You’ll need to enter information like your ZIP code, any prescriptions you have, and your pharmacy. You’ll then see plans in your area that include your prescriptions in their formulary, along with any copayments you’ll be responsible for.
How to use and store EpiPens
- Keep your EpiPen in its container with the lid on.
- Have two EpiPens in a place you can easily get to.
- Store your EpiPens in cool, dark places at temperatures between 59°F and 86°F.
- You should never refrigerate your EpiPen.
- You can keep your EpiPen in a purse or wallet, but it’s important to make sure it doesn’t get too warm or too cold.
- Be careful keeping your EpiPen in your car’s glove compartment on very hot or very cold days.
- It can be a good idea to get a case just for your EpiPens that you can easily transfer from your bag to your desk to your car.
- Check the expiration date on your EpiPen. Your pharmacy can help you safely dispose of an expired EpiPen.
- You can buy practice EpiPen injectors at a low cost. You can use them to get a feel for how to use the EpiPen so you’re prepared for an emergency.
An EpiPen is prescribed for emergency treatment of severe allergic reactions. Your doctor might prescribe you an EpiPen if you have a history of allergies or are at risk for allergic reactions.
An EpiPen is a portable epinephrine injection. Epinephrine works by narrowing your blood vessels and opening the airways in your lungs. This can help you breathe, raise your blood pressure, and reduce any swelling in your throat.
EpiPens and the generic form are sold in packs of two. Your doctor will probably recommend you keep your EpiPens somewhere you can easily access them in an emergency.
Your doctor or pharmacist can also give you instruction on how to use your EpiPen, including:
- when to use your EpiPen
- how to work the EpiPen
- the best spot to give yourself the injection
- how far apart to give yourself injections
It’s important to note that you’ll need to seek emergency medical care even if you use an EpiPen.
The EpiPen can keep you stable until a medical professional can evaluate you. It doesn’t replace the need for medical attention.
When to seek emergency care: symptoms of anaphylaxis
Seek emergency care right away if you or someone else are experiencing:
- shortness of breath
- swelling in your throat
In some cases, a person having a severe allergic reaction might also:
- throw up
- pass out
- feel like their pulse is racing
- develop hives
These signs, in addition to trouble breathing, are a sign of a serious allergic reaction. If the affected person has an EpiPen prescription, it should be given right away. And they’ll need to go to the emergency room as soon as possible.
- EpiPens are prescribed for use during severe emergency allergic reactions. Used correctly, an EpiPen can be a lifesaving measure that allows you to reach the emergency room and get full care.
- EpiPens are expensive, with costs for the brand name reaching over $600 for a two-pack.
- Medicare can help you cover the cost. Most Part D and Medicare Advantage plans include EpiPens or the generic epinephrine in their formulary. Your costs will depend on your plan but could be as low as $0.