FILE – In this July 8, 2016, file photo, a pharmacist holds a package of EpiPens epinephrine auto-injector, a Mylan product, in Sacramento, Calif. (AP Photo/Rich Pedroncelli, File) On a Friday in May I dropped off my kids at school, said a prayer for their safety and health like I do every morning and went on to see my patients in the clinic. That afternoon, I got a call from the school telling me my older son was having a severe allergic reaction, with hives covering his arms and face. The panicked administrator told me their algorithm recommended epinephrine administration, but the EpiPen my son keeps on campus had expired the previous month.
Epinephrine injection, commonly known as the “EpiPen,” is a life-saving drug for kids and adults with allergies. My son has had nut allergies and asthma since childhood, and while we always carry an EpiPen and provide one for the school, thankfully his reactions had never been severe enough to require an injection.
At his most recent allergy appointment, the allergist had told me about the new “Epi First Epi Fast” recommendation by the American Academy of Allergy, Asthma and Immunology emphasizing earlier use of EpiPen instead of waiting for anaphylaxis, the traditional indication of severe life-threatening allergic reaction, to prevent complications from delays and reduce emergency room visits.
While I appreciated the clinical evidence supporting this shift, I questioned how, as medical professionals, we can recommend an earlier and more frequent use of a medication that remains unaffordable for most people. I am a physician with good insurance, but every year we have faced higher out-of-pocket cost for my son’s EpiPen.
This is because Mylan (now part of Viatris), the company which until 2025 held the patent for the auto injector delivery device, continues to hold the monopoly on marketing and distribution, and charges over $400 for a standard Twin Pack. Generic options were not available for many years, and even when the Food and Drug Administration approved them in 2018, they were costly to produce due to strict regulatory and proprietary guidelines around the auto-injector device and complex insurance cost-sharing algorithms.
Unfortunately, the EpiPen is just one example of America’s inflating prescription costs. An AARP report published in May found that prices for the 25 top-selling brand-name prescription drugs increased an average of 81 percent after entering the U.S. market, while lifetime prices for the same drugs fell an average of 13 percent across 19 comparable high-income countries. This is because most developed nations use government price negotiations to cap drug costs, while the U.S. largely lets private pharmaceutical companies set prices.
The truth is, my son’s school had notified me weeks before the episode that his recently purchased EpiPen was expiring, but when I went to the pharmacy, the $420 for a Twin-Pack was nearly double what I had paid last year. I was told my insurance no longer covers EpiPen or the generic because the insurer had opted for a newer brand named Auvi-Q which had to be special-ordered, with a $300 price tag.
Frustrated, I begrudgingly added to my long to-do list the task of comparing prices through the GoodRx App, finding a pharmacy that carries EpiPens with an expiration date of at least six months beyond purchase and requesting a new prescription to be sent to that pharmacy. I had not completed this prior to my son’s unexpected allergic reaction.
Legislators have tried to remedy the problem: The EPIPEN Act, was originally introduced in January 2024 but faced strong opposition from pharmaceutical industry lobbyists and died in the 118th Congress without advancing beyond committee.
This past September, Rep. Doris Matsui (D-Calif.) and Rep. Maxwell Frost (D-Fla.) reintroduced the act, which calls for a $60 cap on out-of-pocket costs for all epinephrine auto delivery systems for patients with employer-based or individually purchased health insurance. Endorsed by multiple medical organizations, the bill is awaiting committee review so it can move to the full House for a vote. Constituents nationwide should urge their representatives to support it.
Meanwhile, at the state level, North Carolina Attorney General Jeff Jackson in April announced an $11 million settlement with Mylan to recover money Medicaid and state health plans had overpaid because of illegal price increases. In May, Maryland and Illinois followed suit. Every state attorney general should hold Mylan accountable.
Such actions have been proven to work. For decades, high insulin costs led to severe complications and sometimes death in diabetic patients who couldn’t afford this life-saving medication.
A multiprong approach fixed the problem: On the federal level, the 2022 Inflation Reduction Act capped out-of-pocket insulin costs for seniors on Medicare. Multiple states launched their own programs ensuring emergency 30-day supplies for those in need at little to no cost. Most impressively, under public pressure, major drug companies slashed their prices and implemented low-cost monthly caps for patients with private or no insurance.
Thankfully, my son’s symptoms cleared after he used his expired EpiPen. But not everyone will be so lucky. Timely access to epinephrine can mean the difference between life and death.
Dr. Diana Sepehri-Harvey is a board-certified osteopathic physician with over 15 years of experience in primary care and osteopathic manipulative medicine. She is founder of the Osteopathic Integrative Medical Center in Sacramento, California and a Public Voices Fellow with The OpEd Project in partnership with the Paul and Daisy Soros Foundation.
Add as preferred source on Google Tags AARP Auvi-Q Doris Matsui epinephrine EpiPen EPIPEN Act epipen cost FDA (Food and Drug Administration) GoodRx App Health insurance Illinois Inflation Reduction Act insulin cap Jeff Jackson maryland Maxwell Frost medicare drug prices Mylan North Carolina prescription drug prices Rep. Doris Matsui Rep. Doris Matsui (D-Calif.) Rep. Maxwell FrostCopyright 2026 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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