Provider Briefing: Epipen Supply in 2026

Epinephrine auto-injectors remain one of the most essential — and most frustrating — prescriptions in allergy and emergency medicine. Despite improvements since the severe 2018-2019 shortage, providers continue to field calls from patients unable to fill their Epipen prescriptions.

This briefing covers the current supply landscape, the factors driving ongoing availability issues, prescribing strategies to improve patient access, and tools that can help your practice stay ahead of the problem.

Timeline: How We Got Here

Understanding the Epipen supply problem requires context:

• 2007-2016: Mylan (now Viatris) gradually raised the price of a 2-pack from approximately $100 to over $600, drawing widespread criticism and congressional scrutiny.
• 2016: Public outrage over pricing led Mylan to introduce an authorized generic at half the brand price and expand patient assistance programs.
• 2017-2018: Manufacturing problems at Meridian Medical Technologies (the Pfizer subsidiary that produces the devices) led to production shortfalls. The FDA placed Epipen on its drug shortage list.
• 2018-2019: The most severe shortage period. Multiple strengths and formulations were listed as unavailable or in limited supply. The FDA took the unusual step of extending expiration dates on certain lots.
• 2020-2023: Supply gradually improved with manufacturing corrections and increased generic competition. However, intermittent shortages persisted, particularly during seasonal demand peaks.
• 2024-2026: The market has stabilized further with multiple products available (Auvi-Q, authorized generics, Symjepi), but spot shortages continue. Regional disparities in availability remain common.

Prescribing Implications

The ongoing supply variability has several practical implications for prescribers:

Write for the Class, Not Just the Brand

Consider writing prescriptions for "epinephrine auto-injector" rather than specifically for "EpiPen" when clinically appropriate. This gives pharmacists flexibility to dispense whichever product is in stock — whether that's the Epipen authorized generic, Adrenaclick, or another FDA-approved device.

However, be aware that state substitution laws vary. In some states, pharmacists cannot substitute between different auto-injector devices (e.g., Epipen to Adrenaclick) without a new prescription, even if the active ingredient is identical. Writing a device-agnostic prescription can preempt this barrier.

Prescribe Adequate Quantities

Current guidelines recommend prescribing at least two auto-injectors per patient (the standard 2-pack), with consideration for additional sets for school, workplace, and travel. For patients with a history of biphasic reactions or those who live far from emergency services, additional doses may be warranted.

Educate on All Available Devices

When prescribing or renewing an epinephrine auto-injector, take a moment to review the patient's device technique — especially if they may receive a different product than they're accustomed to. Key differences between devices include:

• Epipen / authorized generic: Remove blue safety cap → press orange tip against outer thigh → hold 3 seconds
• Auvi-Q: Pull off red safety guard → press black end against outer thigh → voice prompts guide through injection
• Adrenaclick: Remove both end caps → press against outer thigh → hold
• Symjepi: Remove cap → push plunger to inject (manual syringe)

Availability Picture in 2026

The current landscape includes several products, each with its own supply profile:

• Epipen / Epipen Jr (Viatris): Generally available but subject to periodic regional shortages, particularly during back-to-school season. Both 0.3 mg and 0.15 mg formulations.
• Authorized generic epinephrine auto-injector (Viatris): Same device as brand-name Epipen. Often more consistently available due to lower demand relative to brand name.
• Auvi-Q (Kaléo): Stable supply. Available in 0.1 mg, 0.15 mg, and 0.3 mg. The 0.1 mg dose for infants (16.5-33 lbs) is unique to this product.
• Adrenaclick / generic: Generally available. Different device mechanism.
• Symjepi (Sandoz): Pre-filled syringe, not auto-injector. Available in 0.15 mg and 0.3 mg.

For real-time availability data across pharmacies, Medfinder for Providers offers a search tool that can help your practice direct patients to pharmacies with current stock.

Cost and Access Barriers

Even when Epipen is available, cost remains a significant barrier to patient adherence. Many patients report rationing, using expired devices, or going without because of price:

• Brand-name Epipen: $300-$700+ per 2-pack (cash price)
• Authorized generic: $150-$400 per 2-pack (cash price)
• Auvi-Q: $0 with commercial insurance through Kaléo's copay program; higher cost without the program
• Insurance copays: Typically $25-$75 depending on formulary placement (usually Tier 2-3)

Providers can help patients navigate cost barriers by:

• Recommending the authorized generic when brand Epipen is prescribed
• Informing patients about manufacturer savings programs (Viatris EpiPen Savings Card, Kaléo's Auvi-Q $0 copay program)
• Referring uninsured patients to patient assistance programs (Viatris PAP, NeedyMeds, RxAssist)
• Directing patients to cost-saving resources

Tools and Resources for Your Practice

Several tools can help your practice manage the Epipen availability challenge:

• Medfinder for Providers: Real-time pharmacy availability search. Help patients locate in-stock pharmacies without tying up your phone lines.
• FDA Drug Shortage Database: Monitor current and resolved shortages for epinephrine auto-injectors.
• Manufacturer savings programs: Keep printable information about Viatris and Kaléo savings programs in your office for patients.
• Allergy action plan templates: Ensure plans reference the generic medication name and include instructions for multiple device types.

Looking Ahead

The epinephrine auto-injector market is slowly becoming more competitive, which should continue to improve both availability and pricing over time. Key developments to watch:

• Potential new entrants to the auto-injector market from additional generic manufacturers
• Ongoing FDA efforts to streamline the generic approval pathway for complex drug-device combinations
• State-level legislation expanding access (e.g., allowing pharmacists to prescribe epinephrine auto-injectors without a physician prescription)
• School and public entity stocking laws that increase community access to epinephrine

Final Thoughts

The Epipen shortage has evolved from an acute crisis to a chronic management challenge. Providers play a critical role in ensuring patients maintain access to epinephrine by writing flexible prescriptions, educating about all available devices, addressing cost barriers, and using tools like Medfinder to help patients locate available stock.

No patient with anaphylaxis risk should go without an epinephrine auto-injector. With proactive prescribing strategies and awareness of the current market, providers can help close the access gap.