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High Costs, Shortages Stand as Barriers for Obtaining Epinephrine Autoinjectors
A survey reported that among 98.3% of respondents prescribed an epinephrine autoinjector for food allergies, 75.1% expressed concern about obtaining it.
Main barriers to obtaining epinephrine autoinjectors for food allergies include drug shortages and high costs, a recent study found.1
“This study provides insight into responders' personal experiences regarding the barriers that were faced when attempting to obtain [epinephrine autoinjectors],” wrote investigators, led by Nadia Baichoo, MA, from division of allergy & immunology at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health.
Last May, the US Centers for Disease Control and Prevention (CDC) reported that the prevalence of food allergies has increased by 50% since the 1990s, making food allergies a serious public health concern.2 According to 2021 reports, approximately 6% of US adults and children have food allergies.3
Along with the increased prevalence of food allergies, the demand for epinephrine autoinjectors has also increased. This life-saving treatment may be difficult to obtain, with many barriers to access. Investigators sought to gather the experiences and challenges patients with food allergies face when trying to obtain epinephrine autoinjectors.
The team conducted a 41-question survey through the FARE (Food Allergy Research & Education) Patient Registry on demographic data and patients experiencing difficulty obtaining epinephrine autoinjectors.1 The survey was distributed via Redcap to 10,599 registered FARE users, and among 1984 responses, 1884 were completed.
Among the sample, 98.3% (n = 1908) were prescribed an epinephrine autoinjector for food allergies. Required autoinjectors included Epi Pens (34.9%), Epi Pen Jr (12%), epinephrine (19.5%), epinephrine 0.15 (5.6a6), Auvi-Q 0.3 (27.5%), Auvi-Q 0.15 (4.4%), Auvi-Q 0.1 (0.3%), Symjepi 0.3 (0.3%), Adrenaclick 0.3 (3.3%), Adrenaclick 0.15 (0.8%), and other (2.8%).
More than a third of respondents (37.7%; n = 720) reported difficulties in obtaining epinephrine autoinjectors. Children and teenagers aged < 18 years (n = 1108) experienced greater difficulty obtaining the treatment than adults ≥ 18 years (n = 731).
An EpiPen was the hardest for children to obtain (38.3%; P < .0001), followed by Auvi Q (33%), epinephrine (22.7%), and Adrenaclick (3.7%). Among adults, EpiPen was also the hardest to obtain (51.2%; P = .0738), followed by epinephrine (25.9%), Auvi Q (13.4%), unlisted brands (6.5%), and Adrenaclick (3%).
The survey identified drug shortages (67.2%) and high costs (43.6%) as the main barriers to obtaining epinephrine autoinjectors. Additionally, 34% of free-text comments mentioned cost concerns. Out-of-pocket costs for this treatment ranged from $0 - $10 (20.9%), $10 - $20 (9.8%), $20 - $50 (22.3%), #50 - $100 (13.8%), and > $100 (33.1%).
Many responders (75.1%) expressed concern or anxiety about obtaining their epinephrine autoinjector. Respondents who reported greater confidence and satisfaction levels used their epinephrine autoinjector, and those prescribed Auvi-Q. Additionally, respondents who used their original epinephrine autoinjector brand reported fewer issues.
Although most participants were prescribed an epinephrine autoinjector for food allergies, only 44% used one, and 24.3% used it within the last year. Nearly a quarter of respondents (24.8%) required several doses.
Investigators noted that the study was limited by the self-reported food allergy diagnoses and the response rate of 18.7%; however, similar studies had response rates between 5% to 30%. The team also wrote that the findings had no objective correlations with prescription rates.
“Insurance-related factors, high costs, and delays in obtaining prescriptions contribute to significant anxiety and dissatisfaction,” investigators concluded. “Efforts to reduce costs, enhance insurance coverage, and ensure consistent training on [epinephrine autoinjectors] are also crucial for improving patient outcomes, quality of life, and reducing healthcare disparities. Ensuring equitable access to [epinephrine autoinjectors] is imperative to address these pressing concerns.”
References
Baichoo N, Fishbein J, Ponda P. Access to Epinephrine Autoinjectors, the Patient Perspective. Allergy. 2025 Mar 29. doi: 10.1111/all.16534. Epub ahead of print. PMID: 40156482.
Glim, M. Digging Up the Roots of Food Allergies. NIH: Intramural Research Program. May 17, 2023. https://irp.nih.gov/blog/post/2023/05/digging-up-the-roots-of-food-allergies#:~:text=If%20it%20seems%20like%20food,a%20serious%20public%20health%20concern. Accessed April 18, 2025.
More Than a Quarter of U.S. Adults and Children Have at Least One Allergy. CDC. January 26, 2023. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220126.htm. Accessed April 18, 2025.
