Syringe with drop of solution / Dramatic Increase in Cost of Medical Device EpiPen Prompts Patients to Find Alternatives
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A 400 percent increase in the cost of EpiPens is leading patients to look at generic and DIY treatments

August 22, 2016

Many people have at least one allergy of some kind, ranging from pollen to dust to pets and beyond. Most of these allergies result in little more than sniffles, sneezing, and red, itchy eyes. However, some people have allergies that cause a serious, even life-threatening, reaction. This type of reaction, often associated with food allergies, is known as anaphylaxis, and it is a terrifying experience. Fortunately, there is hope for patients who experience such reactions: the EpiPen.

Or at least, there has been hope.

The first thing consumers should know about the EpiPen is that it is not a treatment in and of itself. Its purpose is to slow down the allergic reaction long enough for the patient to get to a hospital; it does not stop the reaction altogether.

The EpiPen dispenses a drug called epinephrine using a syringe-like injector. The technique for injecting the drug, which is basically a shot of adrenaline, is so easy that even children can do it.

The problem with the EpiPen is the cost. The price has skyrocketed by more than 400 percent over the past nine years, says Consumer Reports, beginning at the time that the device was purchased by Mylan. Although a single dose of epinephrine costs only a few cents to make, drug price comparison website GoodRx, which compares prices of drugs at local pharmacies according to a location set by the user, places the lowest cost of the device at pharmacies in Raleigh zipcode 26712 at $616. With a coupon.

An EpiPen prescription will get the patient one package containing two devices. But two may not be enough, especially if the patient is a child. Not only should the child have a device on his person at all times, many parents will also want his teacher, a school nurse, and even other school administrators to have one as well, not to mention having at least one at home.

The costs add up very quickly. What can patients do?

It turns out that there are a couple of options available. Competitor Auvi-Q was recalled in 2015 due to potentially inaccurate dosage delivery, but new manufacturer Kaléo is considering how the device can be brought back to the market. In the meantime, there's generic injector Adrenaclick.

Adrenaclick is slightly different from the EpiPen, says Consumer Reports. It contains the same drug, epinephrine, in the same doses; however, it is far cheaper, with the lowest price coming in at $141.67 for Raleigh 27612 on GoodRx. It is also used differently and does not use the same technology, which EpiPen holds a patent on. It is the former that most concerns Barbara Young, Pharm.D., from the American Society of Health-System Pharmacists.

"The key concern for using different epinephrine products is that patients may not be aware of differences in how you use the injector," she says. Adrenaclick requires a different set of instructions from those for the EpiPen, which could lead to patients using the device incorrectly and thereby delay treatment or even cause injury.

Young recommends that patients ensure that they understand how to correctly use Adrenaclick before they leave the pharmacy, and they should also consider scheduling a training session.

In an endeavor to save even more money, some patients have begun creating their own injection devices with a manual syringe and vials of epinephrine, which costs a few dollars per vial. However, this method is more complicated, and the patient may receive either too much or too little of the drug upon use. They will also need to be trained by a doctor or pharmacist on how to inject it correctly and quickly before actually attempting to use it.

In addition, patients also have to work with their pharmacists to get the correct amount of epinephrine, especially for children, due to the number of different concentrations available. And both syringe and drug must be replaced every three months or so because the drug will lose its potency after that time.

Due to these complications, this option is not desirable, but that may not matter for some patients.

"While switching to a needle and syringe is not ideal," says Andrew Murphy, M.D., board-certified allergist at the Asthma, Allergy and Sinus Center located in West Chester, Pennsylvania, "it may be the only choice some patients have."

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