Epipen® Medicare Coverage

Epipen is a prescription medication that contains the active ingredient Epinephrine. Epipen is given in the event of emergency allergic reaction. It is injected into the muscle and can be used every 5 to 15 minutes if allergic reaction symptoms don’t resolve.

Epipen stimulates beta-receptors in the body that relax muscles in the throat and stimulate the heart to carry more oxygen through the body.

The most common side effects from Epipen include feeling excited or nervous, anxiety, restlessness, shakiness, nausea and vomiting, sweating, headache and fast heart rate.

Does Medicare cover Epipen?

No. Medicare Advantage plans and Medicare Part D plans do not typically cover Epipen.¹

You may be able to find Medicare Advantage plans or Part D plans that cover other drugs that help treat severe allergic reactions.

• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.²
  
  
• Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Average costs for Epipen with Medicare drug coverage¹

Because Medicare Advantage plans and Medicare Part D plans do not typically cover Epipen, you will likely be responsible for all costs for this drug if you have one of these types of Medicare coverage.

Additional information

If you use Epipen, you should keep this medicine with you at all times in case of an allergic reaction.

Epipen should be injected into the outer part of the mid-thigh to manage an emergency allergic reaction. Each Epipen contains only 1 dose.

In the event of an emergency allergic reaction, you need to visit a hospital as soon as possible, even after use of the Epipen. It is recommended to give one dose for every 10 to 20 minutes of travel time to an emergency room.

More than 2 Epipen doses should only be administered under direct medical supervision. Do not inject into the fingers, hands or feet, because this can lower blood flow to these areas.

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

Written by Hayden Gharibyar, Pharm.D.