Fact Checked

How Much Is an EpiPen?

Allergies are a fact of life for many Americans, with an estimated 30 percent of all U.S. adults and 40 percent of all U.S children suffering from allergies. For many people, allergies may cause symptoms that are frustrating and uncomfortable, like sneezing, itchy eyes, or congestion, but these symptoms are usually not dangerous. For a smaller percentage of the population with allergies to food, insect stings, or medication, the consequences of exposure to an allergen can be much more serious, sometimes leading to a fatal reaction. An estimated 200,000 people visit the emergency room each year for food allergies, and reactions to medications are responsible for an estimated 20 percent of all fatalities caused by allergic reactions. People with known severe allergies are often told to carry an EpiPen with them in the event of an allergic reaction, but with the costs of prescriptions rising daily, patients often find themselves asking “How much is an EpiPen?”

What Is an EpiPen?

If you’ve ever been called an “adrenaline junkie” or heard the term “adrenaline rush,” you’re already familiar with one of the names for epinephrine, the active ingredient in EpiPens. If you have serious allergies that can cause a dangerous or deadly reaction, unfortunately, you know all too well exactly why epinephrine is so important. An EpiPen is an epinephrine auto-injector, injecting a synthetic form of adrenaline. Adrenaline is a substance naturally produced by the body under stress that helps prepare the body for a “fight or flight” response. Depending on which part of the body needs adrenaline at the time, adrenaline can perform actions like increasing the heart rate, increasing blood pressure, expanding the air passages in the lungs, and altering the body’s metabolism.

What Is an EpiPen Used For?

EpiPens are used for the treatment of life-threatening allergic reactions called anaphylaxis. Anaphylaxis is triggered by exposure to a specific allergen, usually, a type of food, biting or stinging insects, medication, latex, or other triggers. Common triggers of anaphylaxis include peanuts, shellfish, bee stings, penicillin, and latex. An anaphylactic reaction often appears similar to typical allergic reactions, at least at first. Early symptoms may include a runny nose or a rash, but the reaction escalates within about 30 minutes of exposure to the allergen. Some of the serious symptoms of anaphylaxis include:

  • Coughing, wheezing, or tightness in the chest
  • Fainting, dizziness, confusion, or weakness
  • Shortness of breath or trouble breathing
  • Rapid heartbeat
  • Hives, a rash, or itchy skin
  • Swollen facial features, including the lips or tongue
  • Swollen or itchy throat, trouble swallowing, tightness in the throat
  • Vomiting, diarrhea, or cramps
  • Weak pulse 
  • Paleness

Everyone experiences the symptoms of anaphylaxis differently, but many people experience hives, itching, swelling of the lips, tongue, and the roof of the mouth, and flushing, and airways are often affected. Although some people use the term “anaphylactic shock” interchangeably when talking about anaphylaxis, they refer to two different things. Anaphylactic shock is a symptom of anaphylaxis and occurs when critical organs of the body do not receive enough blood flow during an allergic reaction. Not all patients experience anaphylactic shock. Regardless of the type of symptoms a person suffers when experiencing anaphylaxis, they need to receive an epinephrine injection. Epinephrine injections are the only recommended first-line treatment for anaphylaxis, and they should be administered as quickly as possible. EpiPens stop the anaphylactic reaction from progressing further and begin to reverse the symptoms of the reaction. 

How Do EpiPens Work?

EpiPens work by rapidly injecting epinephrine, the synthetic version of adrenaline, into a patient suffering from anaphylaxis. Epinephrine is a chemical that tells the body to narrow the blood vessels and open the airways in the lungs, helping the patient to breathe more easily. The epinephrine stops the onset of the reaction and reverses severe low blood pressure, wheezing, hives, and severe skin itching within minutes. The medication can be life-saving, but patients will still require further treatment. Some patients may need to administer a second dose of EpiPen when the effects begin to wear off if they are not able to get to the emergency room quickly enough. Patients should seek medical attention immediately after using the EpiPen to get further treatment and observation. 

How Much Is an EpiPen?

EpiPens are necessary medication for people with severe allergic reactions, and they must be purchased each year and carefully stored in order to maintain their stability and mind the expiration date. Unfortunately, EpiPen prices are notoriously expensive, and for people who need to carry them at all times in case of a life-threatening allergic reaction, the cost is a major burden that sometimes feels insurmountable. EpiPens come in two forms, EpiPen and EpiPen Jr., with the latter being sized for children weighing between 33 and 66 pounds. EpiPens are sold in two-packs due to the need to have two on hand in case of a severe reaction which requires a second dose of the drug. Cash prices for the brand name EpiPens reach in excess of $600 or more, and the manufacturer of the medication, Mylan, was found to have employed price hikes for EpiPen drug prices by 400 percent between 2011 and 2016. During this time period, EpiPens were the only treatment for anaphylaxis on the market, as a major competitor had been discontinued in 2012. With no other brands or generics on the market, prices for EpiPens skyrocketed. Today, cash prices for a two-pack of a generic form of epinephrine injectors still retail at nearly $400, which is not affordable for the majority of Americans. The manufacturer of EpiPens manufactures its own generic version of the drug, and several other competitors are now marketing generic EpiPens, including Adrenaclick, Auvi-Q, and Twinject.

Fortunately, the authorized generic version of epinephrine is a prescription drug covered by most insurance companies, including Medicaid and Medicare. Patients with high-deductible plans may be responsible for a large portion of their EpiPen costs even with insurance plans. However, many patients find that they can receive a less expensive pocket cost for their EpiPens by using a pharmacy discount card like USARx. USARx is not a type of health insurance; it is a pharmacy discount program that negotiates directly with the drug manufacturer and pharmaceutical company to provide lower pricing for all FDA-approved brand name and generic alternatives at participating pharmacies. Savings with USARx can reduce the list price of injectable EpiPens, the generic version of EpiPen, and other competitors substantially.

Some patients may also qualify to use a savings card from the makers of EpiPen and its generic or may qualify for its patient assistance program. Restrictions to both programs apply. For example, the savings card is not available for patients who have insurance coverage under Medicare, Medicaid, or other state or federally funded healthcare programs. Access to the patient assistance program is limited to participants who are US citizens or legal residents living in the United States and who are able to prove that their gross yearly household income falls below 400 percent of the current federal poverty guidelines based on family size. Additional requirements regarding insurance coverage and access to insurance also apply, and patients will need to provide documentation of their eligibility. Information on these savings programs is available directly through the manufacturer’s website.

What Are the Benefits of EpiPens?

As the only drug recommended for first-line treatment of anaphylaxis, epinephrine injections like EpiPens have many benefits:

  • EpiPens can be life-saving when used during an anaphylactic reaction.
  • EpiPens are available in two dosages, including one for patients over 66 pounds and one for patients between 33 and 66 pounds.
  • EpiPens use an auto-injector to deliver epinephrine.
  • Epinephrine injections work quickly to reverse the symptoms of anaphylaxis, so its effects are noticed immediately.

What Problems Are Associated With EpiPens?

Although EpiPens are life-saving, they aren’t perfect, and there are many complaints about the medication:

  • EpiPens are bulky and inconvenient to carry around, which means patients may not have them when they need them most.
  • EpiPens and their generic forms are prohibitively expensive for many people.
  • More than one injection may be required.
  • Patients still must seek treatment following an anaphylactic episode, even after using an EpiPen.
  • Patients with hypertension (high blood pressure) or hyperthyroidism may have worse or more persistent side effects associated with EpiPen use. 
  • Patients with coronary artery disease may experience angina with EpiPen use.
  • Patients with diabetes can develop increased blood glucose levels after administering the medication.
  • Patients with Parkinson’s disease may experience a temporary worsening of symptoms after injection. 

When Should I Use an EpiPen?

EpiPens and epinephrine injections should be used whenever you or someone you are caring for shows signs or symptoms of anaphylaxis. Antihistamines are used to treat minor allergic reactions, such as a runny nose or itchy skin, but they are not effective in treating anaphylaxis. Anaphylaxis can be life-threatening, and every second counts, so it is imperative that you administer an EpiPen injection as quickly as possible after noticing signs of a reaction. Following the administration of an EpiPen injection, you should seek medical treatment for yourself or the person suffering from the reaction, as additional treatment and observation are needed. 

What Are the Side Effects of EpiPens?

Side effects associated with Epipens and epinephrine injections are categorized as either common or uncommon. Common side effects associated with EpiPens that usually do not need medical attention include:

  • Fast or pounding heartbeat
  • Nervousness
  • Sweating
  • Nausea
  • Vomiting
  • Trouble breathing
  • Headache
  • Dizziness
  • Anxiety
  • Shakiness
  • Pale skin

If these side effects continue or get worse, notify a doctor or pharmacist.

Some side effects of EpiPen injections do require immediate medical attention. Check with your health care provider immediately if you experience any of the following uncommon but serious side effects after administering an EpiPen injection:

  • Irregular heartbeat
  • Signs of infection at the injection site, including redness that does not subside, warmth, swelling, or pain)
  • Chest pain
  • Fainting
  • Vision changes
  • Seizures
  • Confusion

Regardless of whether or not you experience side effects after an epinephrine injection, you need to seek medical treatment and observation after administering the drug. 

Are EpiPens Safe for Pregnant and Breastfeeding Women?

The use of epinephrine injections during pregnancy or nursing is somewhat complicated because the medication is life-saving for people suffering from anaphylaxis. It must be administered in the event of an anaphylactic reaction. However, it is recommended that the medication be used with caution during labor and delivery and should be avoided, if possible, during the second stage of labor. EpiPen use should be avoided during pregnancy if the mother’s blood pressure is higher than 130/80; however, as noted, epinephrine injections are life-saving medications that are only used in case of an emergency. Pregnant or nursing women who are concerned about EpiPen use during pregnancy should speak to their doctors. 

Who Should Not Use an EpiPen?

Certain medical conditions may be exacerbated by the use of an EpiPen. People with the following medical conditions should speak to their doctor before using an EpiPen:

  • Patients with hypertension (high blood pressure) or hyperthyroidism may have worse or more persistent side effects associated with EpiPen use. 
  • Patients with coronary artery disease may experience angina with EpiPen use.
  • Patients with diabetes can develop increased blood glucose levels after administering the medication.
  • Patients with Parkinson’s disease may experience a temporary worsening of symptoms after injection. 

People taking the following medications should inform their doctors prior to using an EpiPen, as the medications may interact:

  • Patients taking beta-blockers, such as propranolol, may experience a drug interaction when using an EpiPen. 

EpiPens and epinephrine injections can cause dizziness, so patients should not drive, use machinery, or do anything requiring alertness while using epinephrine. Alcoholic beverages and marijuana should be limited, as this can increase dizziness and exacerbate symptoms. 

Ultimately, EpiPens are a life-saving medication that should be used when needed during an anaphylactic reaction. It is important to communicate your medical history to your doctor so that you know what reactions or interactions to be aware of, but your life may be at risk during an anaphylactic reaction if you do not receive treatment with epinephrine quickly. 
 

Published July 4th, 2020 by Bridget Reed
Fact Checked by Chris Riley

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