EAIs Still in Short Supply

It’s a scary situation when you go to fill a prescription of a brand name EAI device and there are none available. With a shortage still going on particularly for pediatric dosages, there are some viable alternatives such generic brands and the AUVI-Q. For more information on alternatives to the Mylan Epi-PenTM and an editorial on the current situation, see the full article here:

EAIs Still in Short Supply

Illustration by Jon Terry

March 15th, 2019
By Kristen Stewart

With spring almost here we can see changes all around us from warmer weather to longer days. Unfortunately, we are not seeing anything different when it comes to the availability of epinephrine auto-injectors (EAIs).

A recent survey of pharmacies in the Albany, New York area found 60% had no brand name EAIs in stock, and of those who did they were often in very short supply and/or didn't have all dosing options available. Generics fared a bit better with 80% of polled pharmacies reporting having one or more at their store in at least one dosing amount.

A similar situation was echoed by Dr. Steve Moore, President-Elect of the Pharmacists Society of the State of New York, and a pharmacist in Plattsburgh. "There is still a shortage from what we're seeing," he said. "The brand name EAIs are unavailable. There's an issue with the pediatric dose and some of the generics in particular are not available in either strength. We have one generic and it's the adult dose and we don't have any of the pediatric. So while we do have something we don't have everything."

The one small bit of good news is that all of the pharmacists surveyed were aware of the ability to dispense a generic epinephrine autoinjector in place of the brand name unless the prescribing doctor indicated otherwise. As long as the phrase "DAW" (Dispense as Written) is not included on the prescription by the doctor, the generic version will be issued if one is available.

"From our perspective we're always dispensing the generic unless there's a particular reason like maybe a shortage with the generic or somebody wants the brand in particular," said Moore. However, he notes there can be an issue if the brand and generic are too dissimilar. For example, even though the medication within the EAIs are often the same, the syringes to administer them can be set up differently which precludes the ability to substitute one for another as current law is written.

For people having trouble finding brand name and generic EAIs, the AUVI-Q could be another option through its manufacturer Kaleo's collaboration with Walgreens and its own direct delivery service. The AUVI-Q has never been as popular because of the cost, according to Moore, and more than half of the pharmacies surveyed didn't realize these other avenues of distribution for it.

In the case of any EAI that is new to the patient, whether it is a different generic, AUVI-Q or something else, patients and caregivers should always read the instructions before needing to use the device said Moore. Even though the medication within the device is the same, the method of delivery may be different and the time to figure out how to administer it is not in the middle of an allergic reaction.

Another option for people unable to find EAIs in stock is to double check the expiration dates on their existing medication said Carole Deyoe, Director of Pharmacy Practice for the Pharmacists Society of the State of New York, as she knows of at least two manufacturers who are extending the expiration dates of their products.

These suggestions are helpful, but the best news will be when brand names and generics are readily available at all pharmacies. Until then the Allergy Advocacy Association will continue to track this issue.

© Copyright Allergy Advocacy Association 2019. 

Editor's note:

In addition to the article written by Kristen Stewart, there have been editorial comments about the EAI device shortage from news media world-wide. For another perspective on the continuing crisis I have added an editorial from another publication. The opinions expressed in The Lancet are solely those of the authors and are not necessarily endorsed by the Allergy Advocacy Association. Please see the article listed below.

Jon Terry, founder

How has it come to this?

Editorial from The Lancet
December 1, 2018

"Pharmaceutical companies should not be able to monopolize a market to the extent that lives are at risk, and clinicians must be resistant to any attempts to influence it. Big pharma should be held accountable for the public health consequences of their quests for maximum profits. Epi-PensTM deliver a shot of epinephrine in a potentially fatal situation. Brand dominance has allowed thousands of families to spend this year reliant on half doses or expired prescriptions of a simple drug that was discovered over a century ago. Generic products have exactly the same intended use, effects, side-effects, and safety as the original, but at a fraction of the cost. It should not take a global shortage of a life-saving product for regulators, health systems, doctors, and pharmacists to realize that where safe and effective generics and competitor products exist, they should be used. There is no place for brand loyalty in the realm of life-saving medicines." 

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