Mercy Family Practice SC

EpiPen Alternative

EpiPen is vital to anyone who has anaphylaxis to food, bee stings, or other antigens. Often EpiPen can be lifesaving. Most guidelines recommend epinephrine as the first line therapy for anaphylaxis and it is recommend that these patients have two EpiPens on hand presumably in case one fails. The prohibitively high cost of EpiPen is cited as the main reason that many patients who need epinephrine go without the medication. Many rely on second-line therapy such as over the counter antihistamines; however, they do not treat anaphylaxis.. It is estimated that 49 million Americans need access to an injectable form of epinephrine. It is estimated that in a city the size of Green Bay, fifty people per year will have an anaphylactic reaction.[1]

My own patients cannot afford an EpiPen. Current price range is from $500 to $600. Furthermore, when the pen reaches its expiration date, it may have never been used and has to be replaced. As a drug, epinephrine was first isolated in 1901. The World Health Organization lists it as an essential medicine.[2] Mylan's CEO, Heather Bresch enjoys an annual salary of $19 million. Recently, she was called before Congress to justify the cost of their product. Mylan acquired EpiPen in 2007. In 2008, the same product cost $100. That is a 500% increase, or an annual increase of 71%. In Canada, an EpiPen or its equivalent costs between $60 and $120. The competitors of EpiPen's, Sanofi which made Auvi Q and Amedra which made Adrenaclick are no longer available on the market. Maylan enjoys a monopoly on the market. Epinephrine is a small molecule. The FDA usually allows a patent for small molecules of only 6 years. Mylan has marketed their product for over 8 years. This means that free market forces are not at play.

I have recently priced my own EpiPen alternative: epinephrine ampules, a 30 gage needle, and a 1ml syringe. The cost comes to $12.17 for two syringes:

Epinephrine ampule1ml19.710.30 5.91
Needle 27 G ½ in 100 5.771 0.06
Syringe 1 ml10010.591 0.11
2 pens12.17

This means that Mylan has a markup of 4,932%.

If you are my patient, and you want to have this available for yourself, you call by my office, and we can discuss how to get you a supply of epinephrine for under $13.00.. If you are not my patient, then by law I need to establish a relationship with you before I can prescribe a medication. This means a short office visit. You need to be older than 14 years of age. For a focused exam I charge $50 for the visit, which includes the medication, which is still cheaper than securing the medication through any other means.


  1. Fromer, Leonard MD, Prevention of anaphylaxis: the role of the epinephrine auto-injector, The American Journal of Medicine, Oct 10, 2016,click here
  2. Wikipedia: [accessed 09/15/2016].
  3. Garver, Rob, Lawmakers Say EpiPen Maker Bilked Medicare for More than $100 Million, The Fiscal Timesclick here

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