Q&A with Sung Poblete

Allergists insist that epinephrine is the only first treatment for an anaphylaxis emergency. Yet during the past 15 years the cost of epinephrine has sky-rocketed to unaffordable heights for many patients. Sung Poblete, PhD, RN, CEO of Food Allergy Research and Education (FARE), answers important questions about how the effect of these costs can be lessened, improving access to life-saving epinephrine auto-injector (EAI) devices.

Find ways to make epinephrine affordable.

Q&A with Sung Poblete:
Programs Aim to Reduce Epinephrine Costs for Families with Food Allergies

Woman injects epinephrine into her left thigh

By Richard Gawel
By Sung Poblete, PhD, RN
Fact checked by Kristen Dowd

August 10, 2022

Although epinephrine could be a lifesaving drug for the 32 million people in the United States with food allergy, costs can make obtaining its protection difficult.

UnitedHealthcare recently eliminated out-of-pocket costs for epinephrine among the patients it covers, but more work remains, Sung Poblete, PhD, RN, CEO of Food Allergy Research and Education (FARE), told Healio.

Healio spoke with Poblete about the current state of epinephrine costs, the effect of these costs on families with food allergy and the strategies to ease these burdens and potentially save lives.

Healio: Why is access to epinephrine vital for families with food allergies?
Poblete: Simply put, epinephrine is lifesaving, and access to epinephrine is critical in life-threatening food allergy situations. Once a serious allergic reaction (anaphylaxis) starts, the drug epinephrine is the only effective treatment. Not treating anaphylaxis promptly with epinephrine increases the risk for a fatal reaction.

Sung Poblete, PhD, RN
Sung Poblete

Access to epinephrine, however, remains a challenge. FARE is working diligently to broaden access to epinephrine by breaking down barriers such as cost, patient diversity and availability, all in the interest of providing safe and affordable peace of mind to families faced with a life-threatening food allergic reaction.

Healio: How have the costs for epinephrine changed in recent years? Poblete: Overall, costs for epinephrine have decreased over the past several years, with variables attributable to insurance plans and coverage. This is in large part due to the release of unbranded generics and more injectable options, although epinephrine may still be expensive for those on a high-deductible insurance plan.   FARE is heartened by the recent initiative taken by UnitedHealthcare eliminating out-of-pocket costs for epinephrine on its plans, and we encourage other insurance carriers to consider similar measures.

Healio: How have these changes impacted families dealing with food allergy? Poblete: Having access to and paying for epinephrine always have been challenging for food-allergic families. Rising costs add to that negative impact. In fact, data suggest that current anaphylaxis management practices are not optimal and could be assisted by lowered out-of-pocket costs for epinephrine as well as improved patient education efforts surrounding emergency use of epinephrine.   Efforts to control costs, provide education and increase access to epinephrine are all critical to helping impacted families dealing with food allergy.

Healio: What are the current standards of coverage for these medications in private insurance? Poblete: “Standard” coverage for epinephrine varies by insurance carrier and plan, so it is vitally important that patients research their private insurance options carefully. A study by Chua and Conti provides good background information.

Healio: What are the current standards of coverage for these medications in public insurance? Poblete: As with private insurance, public epinephrine coverage varies by plan, but is much more limited than private coverage. Information about Medicare coverage of EpiPen (Viatris) costs is available online. While there is coverage of epinephrine with Medicaid, data from Owusu-Ansah and colleagues suggest barriers to access and under-prescription for the drug.

Healio: Are there any programs or organizations that are working to mitigate these costs? Poblete: Assistance with epinephrine costs ranges from savings cards to Medigap plans, as well as low-income (or patient assistance) plans through individual drug manufacturers and pharmaceutical groups. Many manufacturer assistance programs can be accessed through FARE’s website.

Healio: What kind of success have these programs or organizations seen in their efforts so far? Poblete: While the success of individual programs to lower epinephrine costs varies by program/organization, there is always room for improvement. FARE is committed to working across organizations and platforms to increase access and lower the cost of epinephrine wherever possible.

Healio: What other recommendations does FARE offer to mitigate these costs? Poblete: There is no ideal approach to mitigating epinephrine costs. As such, FARE recommends several steps for cost savings for patients:

  • Talk to your doctor/pharmacist about generic options.
  • Appeal your insurance.
  • Try direct-to-consumer mail options.
  • Shop different pharmacies and investigate benefit or savings cards.

Healio: How can individual clinicians help mitigate these costs for their patients? Poblete: Clinicians can assist in mitigating the cost of epinephrine for their patients in much the same way individuals can help themselves. Often, the combined efforts of patients and their food allergy clinician can result in significant cost savings.

Healio: Where can clinicians go for more information? Poblete: In addition to the many resources available through FARE, helpful information can also be found at the American College of Allergy, Asthma & Immunology and the American Academy of Allergy, Asthma & Immunology.

Healio: Do you have anything else you would like to add?
Poblete: The good news is that more epinephrine options may be on the horizon and research is ongoing. These innovations are critical to improving access to this lifesaving medication. Additionally, many efforts are underway on the legislative and regulatory fronts.
  For example, FARE advocates have lobbied on four distinct issues in the House and three in the Senate focusing on making schools safer for the nearly 6 million children with life-threatening food allergies by reducing the cost of epinephrine autoinjectors and by increasing the federal investment in food allergy research. Growing the Congressional Food Allergy Research Caucus is a priority as well.
  Also of note are epinephrine education and health equity efforts through FARE’s Community Access Program (CAP). CAP initiatives are underway in Newark, New Jersey, and Washington, D.C., with an additional program launch upcoming in Chicago.
  Overall, FARE’s focus on access and education related to food allergies is making huge strides in raising awareness, increasing funding and expanding knowledge about the prevalence and severity of food allergies and the ways in which to manage and hopefully eradicate them.

References:
Chua KP, et al. J Gen Intern Med. 2022;doi:10.1007/s11606-022-07694-z.
Does Medicare Cover EpiPen? https://www.medicalnewstoday.com/articles/does-medicare-cover-epipen#costs. Published Nov. 2, 2020. Accessed Aug. 8, 2022.
Medication affordability assistance programs.  https://www.foodallergy.org/resources/medication-affordability-assistance-programs. Accessed Aug. 8, 2022.
Warren C, et al. Ann Allergy Asthma Immunol. 2018;doi:10.1016/j.anai.2018.06.010.

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