Taking the sting out of the EpiPen price hike - Cape Cod Healthcare

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Published on October 07, 2016

Taking the sting out of the EpiPen price hikeTaking the sting out of the EpiPen price hike

While consumers will have to wait for FDA approval of generic versions of the allergic reaction antidote, EpiPens, manufacturer programs and government health insurance can now make it less expensive to buy them.

Earlier this year, manufacturer Mylan raised the price of a two-pack of its widely used EpiPens, to more than $600, drawing fire from consumers who rely on the epinephrine injector to stave off the deadly allergic reaction called anaphylaxis. This condition can cause rapid heart rate, dropping blood pressure, swelling, hives, vomiting, diarrhea, fainting and difficulty breathing.

Epinephrine, or adrenaline, is a relatively cheap drug to treat anaphylaxis and has been available for decades. It is the EpiPen injection system that consumers crave and doctors prescribe for its ability to easily provide a premeasured dose.

Mylan bought EpiPen in 2007, when a two-pen set sold for about $100.

Theoretically, patients and caregivers could be trained to draw up the correct dose into a syringe from a vial of epinephrine and how to properly inject it, as doctors do. In practice, such training might be forgotten and mistakes made in the rush of an emergency, said Peter Scarafile, pharmacy director for Cape Cod Healthcare. Years might go by before an injection might be necessary, unlike other patients who regularly inject themselves with other medications, such as diabetics.


Although a cheaper alternative product exists, it is regarded as more difficult to use, so is not often prescribed.

“It is just not as good a device”, Scarafile said. “With EpiPen, you eliminate human error.

There’s no alternative, really.”

That other epinephrine delivery system is Adrenaclick, made by Amedra Pharmaceuticals. As with the EpiPen, it is available in two-packs in two dose levels: 0.3 mg for adults and 0.15 mg for children. Sold for about $400, with a coupon from GoodRx it can be purchased for about $142, according to Consumer Reports.

Mylan has responded to charges of price-gouging by offering $300 off for up to six prescription refills via a savings card. EpiPens may be obtained for free if qualifying patients and their doctors apply to the company. To qualify, patients must either not have government-provided insurance, or have both health insurance that only covers generic drugs and a household income less than 400 percent of federal poverty level.

MassHealth will pay the bulk of the cost of EpiPens, according to Scarafile, leaving patients with a co-pay of slightly less than $4, and even that small amount can be waived.

“It’s really a big expense,” Scarafile said of the cost of EpiPens.

Charles Jodoin, director of student services at Falmouth Public Schools, said he believed only a few students in each school had EpiPens, and these were kept in the nurse’s office. In addition, each school had a two-pack, which were replaced annually. The drug expires in 12-18 months, according to Scarafile.

“For the past three years, we have been very fortunate in receiving them free,” via a program for schools offered by Mylan that one of the school nurses discovered, Jodoin said.

Business Insider reported in August that Mylan will market its own generic version of EpiPen next year, and it may sell for about the same price as the standard version when a coupon is used, or about $300.

Other companies are considering generic versions.

“There’s a lot of controversy: What is the right price?” Scarafile said.

The FDA’s director of the Center for Drug Evaluation and Research testified before a Senate hearing on September 21 that it is often difficult for the agency to approve the first generic versions of a drug, according to Morning Consult. Director Janet Woodcock said one of the obstacles in development of generic versions of the EpiPen is that Mylan owns patents that won’t expire till 2025.