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Consumers Seeking Alternatives to Epi-Pen®

EpiPen 2-pack
Rich Pedroncelli/Associated Press

As the outrage over the price of EpiPens continues, Patricia Sabatini offers some practical alternatives such as buying them in Canada or trying a generic version of the former Adrenaclick brand. She also discusses alternatives to avoid such as going online or using a syringe and vial. Hopefully a new, lower priced generic version of the current EpiPen® will be available soon.

As consumers look for more affordable solutions to the rising price of the EpiPen, the increased cost has brought scrutiny by lawmakers and a public backlash for Mylan.

Consumers Seeking Alternatives to Epi-Pen®

By Patricia Sabatini
September 7, 2016

The firestorm surrounding the spiraling price of Mylan’s EpiPen® is fueling interest in lower-cost alternatives to the emergency allergy treatment, including a lesser-known but similar auto-injector that has been on the market since 2013.

The rival product, labeled simply as “epinephrine auto-injector,” is the generic version of a small competitor to the market-dominating EpiPen. Although the Adrenaclick brand is no longer produced, market share for the generic version has grown from about 4 percent at the start of the year to around 7 percent recently, according to a spokesman for the device’s owner, Impax Laboratories based in Hayward, Calif.

As consumers look for more affordable solutions, the rising price of the EpiPen has brought scrutiny by lawmakers and a public backlash for Mylan, including public rallies, an explosion of criticism on social media, and rebukes and investigations by lawmakers. On Tuesday, New York’s attorney general announced an antitrust probe involving EpiPen sales contracts with schools.

Medical officials looking for ways to help their patients cope with the cost of the potentially lifesaving treatment have had few options.

Heightened demand for the generic Adrenaclick isn’t hard to understand. While the EpiPen sells for over $600 a pair, the rival device goes for around $200. Both products also offer manufacturer’s coupons that can bring the cost down for consumers.

Both the EpiPen and the generic Adrenaclick administer a pre-measured dose of epinephrine to counteract severe allergies to bee stings, peanuts and other foods, with slight differences in the way the medication is delivered, said Jonathan Spergel, an allergist at Children’s Hospital of Philadelphia.

“With the EpiPen, you take off one cap, and then you push it. With the Adrenaclick, you take off the cover for the needle and the cap ... so there is an extra step,” Dr. Spergel said.

In addition, after the dose is administered, the EpiPen needle is covered.

With the Adrenaclick, “You can poke yourself,” he said. “Is that a major issue? No,” he said.

With other alternatives limited, “Obviously, interest has increased” in the generic Adrenaclick, said Impax spokesman Mark Donohue, although he declined to divulge sales figures. The cost for the EpiPen has skyrocketed some 500 percent in recent years.

Impax Labs, which acquired the rights to the Adrenaclick and its generic version when it bought Amedra Pharmaceuticals in 2015, is using a third party to assemble the auto-injector manually, Mr. Donohue said. The company hopes to have the process automated by the end of next year or the first half of 2018, he said.

“While we have product available, the amount we can supply to the market is obviously somewhat limited,” he said, adding that the device is available at pharmacies nationwide, including at Wal-Mart.

Dr. Spergel of Children’s Hospital of Philadelphia said that he writes “epinephrine auto-injector” instead of a brand name when prescribing the medication for patients. “I have no personal preference,” he said.

As for other options, patients could keep a syringe and vial of epinephrine on hand at a nominal cost, but Dr. Spergel doesn’t recommend it. “The problem is, people have lots of errors drawing up the epinephrine and can misdose,” he said.

Mylan recently promised to launch a lower-cost generic EpiPen in the coming weeks that is identical to the brand-name device but with a list price of $300 for a two-pack.

Other alternatives could also be on the horizon. They include a generic version of the EpiPen from Teva Pharmaceutical Industries that was rejected by the Food and Drug Administration earlier this year but that the company hopes to launch next year.

Some U.S. patients have reported traveling to Canada to buy their EpiPens, where in an environment of government price controls, the injectors sell for about $200 a pack.

Other frustrated consumers have been turning to online pharmacies based outside the U.S. for cut-rate prescription and over-the-counter medications, although the FDA and other experts advise against the practice.

“Rogue sites often sell unapproved drugs, drugs that contain the wrong active ingredient, drugs that may contain too much or too little of the active ingredient, or drugs that contain dangerous ingredients,” the agency warned on its website.

Outrage over the escalating cost of the EpiPen has sparked several federal lawsuits by consumers in recent weeks, including one filed last week in U.S. District Court in Pittsburgh challenging Mylan’s practice of selling the medicine only in sets of two “as a pretense for charging unconscionable prices.”

Mylan did not respond to emails seeking comment.

On Tuesday, New York Attorney General Eric Schneiderman said a preliminary review had found that Mylan may have broken laws by inserting potentially anticompetitive terms into its EpiPen sales contracts with numerous local school systems.

In a statement to Bloomberg News, Mylan said its schools program adheres “to all applicable laws and regulations.”

Patricia Sabatini
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