North Carolina Reaches $11 Million EpiPen Settlement Over Pricing Practices

Key Takeaways

• North Carolina reached an $11 million settlement with Mylan resolving allegations that the company engaged in anticompetitive practices and overcharged Medicaid and the State Health Plan for EpiPen.
• The state alleged pharmacy benefit manager (PBM)-related formulary manipulation, delayed generic competition, and Medicaid rebate misclassification contributed to rising costs.
• Settlement funds will reimburse state programs, and Mylan agreed to increase co-pay assistance for its authorized generic, while denying wrongdoing.

Overview

North Carolina has reached an $11 million settlement with Mylan Inc, the marketer and distributor of EpiPen autoinjectors, resolving allegations that the company engaged in anticompetitive conduct and overcharged the state for a widely used emergency medication.

The agreement concludes a state enforcement action focused on pricing practices that allegedly increased costs for North Carolina Medicaid and the State Health Plan, both of which will receive a substantial portion of the recovery.

Allegations

According to the North Carolina Department of Justice, the state alleged that Mylan used its market position to maintain dominance and raise prices for EpiPen, a life-saving epinephrine autoinjector.

Key allegations included:

• Anticompetitive conduct to limit generic competition, including delaying market entry of lower-cost alternatives
• Financial arrangements with PBMs to influence formulary placement and restrict access to competing products
• Misleading marketing claims regarding competing generic products
• Misclassification under the Medicaid Drug Rebate Program, affecting rebate obligations owed to the state
• Packaging practices, including requiring the purchase of 2-packs regardless of patient need

State officials alleged that these practices contributed to a significant price increase, with EpiPen costs rising from approximately $100 to $600 over a period of years.

Settlement Terms

Under the settlement:

• Total payment: $11 million
• State Health Plan: $4.2 million
• North Carolina Medicaid: $4.2 million
• Remaining funds: allocated to restitution and related costs

In addition to monetary relief, Mylan agreed to increase its co-pay assistance for the authorized generic EpiPen from $25 to $40.

Mylan denied wrongdoing as part of the resolution.

Impact on State Programs and Patients

The settlement is intended to offset costs incurred by state-funded health care programs, which cover a large population of patients requiring epinephrine autoinjectors.

State officials indicated that pricing practices associated with EpiPen led to increased expenditures for both public programs and beneficiaries.

The adjustment to co-pay assistance may also reduce out-of-pocket costs for some patients using the authorized generic product.

Legal Context

This case reflects ongoing state-level enforcement activity targeting the following:

• Drug pricing practices
• PBM–manufacturer relationships
• Medicaid rebate compliance
• Barriers to generic competition

The allegations parallel broader national litigation involving EpiPen pricing and competition, though this action was brought independently under North Carolina law.

Takeaways for Pharmacists

• Formulary access and PBM dynamics remain central legal risk areas in pharmaceutical pricing cases
• Medicaid rebate classification continues to be a recurring enforcement focus
• Generic competition barriers are a primary driver of antitrust scrutiny
• Settlement structures increasingly include both financial recovery and patient cost provisions

Bottom Line

North Carolina’s $11 million settlement with Mylan underscores continued regulatory scrutiny of drug pricing strategies, PBM interactions, and rebate compliance, particularly for high-cost, life-saving medications with limited competition.

References

1. North Carolina Department of Justice. Attorney General Jackson reaches $11 million EpiPen settlement; Medicaid and State Health Plan to receive millions in refunds. Published April 30, 2026. Accessed May 6, 2026. https://ncdoj.gov/attorney-general-jackson-reaches-11-million-epipen-settlement-medicaid-and-state-health-plan-to-receive-millions-in-refunds/
2.  Kingdollar B. North Carolina reaches $11 million settlement with EpiPen manufacturer overcharging dispute. News From The States. Published April 30, 2026. Accessed May 6, 2026. https://www.newsfromthestates.com/article/north-carolina-reaches-11-million-settlement-epipen-manufacturer-overcharging-dispute