How pharmacists can support patients’ with epinephrine information and alternatives
- Millions of Americans, including many children, have life-threatening allergies. Many of these individuals are prescribed epinephrine to inject in the event of an allergic reaction.
- Pharmacies fill millions of epinephrine prescriptions yearly, as new individuals are diagnosed with allergies and prescriptions must be refilled.
- In recent years, some patients have experienced challenges paying for their epinephrine prescriptions as costs have risen tremendously.
- Pharmacists can help customers by making them aware of various products and programs that enable them to access epinephrine at lower costs.
Challenges for allergic patients
The occurrence of a severe, life-threatening allergic reaction — anaphylaxis — is common in the United States. One recent study found that anaphylaxis very likely occurs in nearly 1 in 50 Americans, and the rate is probably higher, at close to 1 in 20 (5%).1
Those at risk include individuals with food allergies (like peanuts, shellfish or milk), those allergic to insect stings, and those with allergies to medications and latex.2 In total, there are tens of millions of people with allergies,3 many of whom are at risk for anaphylaxis.4 This means that every day there are customers in your pharmacy who have likely experienced a life-threatening allergic reaction or are at risk of experiencing one.
The standard of care for adults and children experiencing anaphylaxis is immediate use of a prescription epinephrine auto-injector.5 Because the number of people at risk is so high, pharmacies fill millions of prescriptions for epinephrine auto injectors each year6 — and the number of prescriptions is increasing as the number of people with allergies continues to rise.7
However, in recent years, some patients’ may have struggled to pay for epinephrine auto-injectors as their cost has increased and many Americans have higher insurance deductibles and co-pays.8 You likely heard about this in the mainstream media and may have heard frustrations from customers.
For some families, the total cost of having multiple auto-injectors for a child or multiple children available everywhere the child frequently goes, such as school or camp, might be thousands of dollars. And, these auto-injectors may not be covered by insurance.9
How pharmacies can help
There is valuable information that pharmacies can provide to help patients get the epinephrine auto-injectors they need at the lowest possible cost. Consider these steps:
- Alert patients’ to the introduction of new generic auto-injectors. The market leader in the epinephrine auto-injector market has been EpiPen®, made by Mylan, Inc. On December 16, 2016, Mylan launched an authorized generic version of EpiPen Auto-Injector. This generic product has a wholesale acquisition cost (WAC) of $300 per two-pack, which is more than 50% below the WAC of the branded version. This new generic product has the same drug formulation and same device functionality, and is administered in the same way as the EpiPen, which has been on the market for nearly 30 years.10 Mylan is also offering a savings card for eligible patients with commercial health insurance, providing up to $25 off the out-of-pocket cost for this authorized generic product.
- Make patients’ aware of discounts on the branded EpiPen. In addition to introducing an authorized generic version, market leader Mylan is offering an EpiPen Savings Card. Eligible patients (mainly those with commercial insurance, not those who are uninsured or covered by government programs like Medicare or Medicaid) can save up to $300 on each EpiPen 2-Pak®. The intent is to help insured patients’ with their co-pay. Patients’ can download a card and present it at the pharmacy when filling their prescription. (Instructions are provided for pharmacists here.)
- Direct patients’ to patient assistance programs. Mylan has a patient assistance program that offers free medication to patients’ who otherwise cannot afford their medications. Patients must meet financial and other program-specific criteria to be eligible for assistance. More information is available here.
- Make patients’ aware of alternatives. While EpiPen is the leader in the epinephrine auto-injector market, there is another option available:11
- Adrenaclick, manufactured by Impax Laboratories, provides an alternative epinephrine auto-injection device that provides the same dosage of epinephrine as the EpiPen.
- Adrenaclick’s price is lower than EpiPen’s.
- Consumer Reports recently reviewed and recommended Adrenaclick.
- Per Consumer Reports, pharmacists in more than a dozen states, including California, Florida, Connecticut, Washington, and Vermont, can substitute Adrenaclick for an EpiPen prescription without having to go back to the prescribing physician. In other states, automatic substitution is not allowed. For this reason, for patients’ interested in the flexibility to possibly choose an alternative, it is important to have doctors write prescriptions for an “epinephrine auto-injector,” not for one specific brand. This provides greater latitude to pharmacists and patients’ in choosing how to fill the prescription.
- Stay on the lookout for other new product offerings. Two additional epinephrine auto-injector offerings are the horizon:
- Kaleo, the owner of AUVI-Q, which was previously on the market, plans to reintroduce its AUVI-Q epinephrine auto-injector in 2017.12
- Teva also hopes to introduce an epinephrine auto-injector in the U.S. in 2018.13
These products and programs are all good news. They provide ways for pharmacists to help patients get the epinephrine auto-injectors they need to respond to a life-threatening anaphylactic event at a more reasonable cost. Providing patients’ with information and expertise reinforces the role of independent pharmacies as trusted healthcare advisors who help patients’ with their health and with navigating the healthcare system.
1 “New Study Shows Nearly 1 in 50 At Risk for Severe Allergic Reactions,” Asthma and Allergy Foundation of America, October 21, 2013. LINK
2 “Risk of Anaphylaxis Now 1 in 50 People,” Allergic Living, October 2013. LINK
3 “Allergy Facts and Figures,” Asthma and Allergy Foundation of America. LINK
4 “As Epipen Prices Skyrocket, Consumers and EMTs Resort to Syringes for Severe Allergies,” PBS Newshour, July 6, 2016. LINK
5 “New Study Shows Nearly 1 in 50 At Risk for Severe Allergic Reactions,” Asthma and Allergy Foundation of America, October 21, 2013. LINK
6 “As Epipen Prices Skyrocket, Consumers and EMTs Resort to Syringes for Severe Allergies,” PBS Newshour, July 6, 2016. LINK
7 “EpiPen Prescriptions Continued to Climb, but Market Share Dropped,” STAT, October 25, 2016. LINK
8 “As Epipen Prices Skyrocket, Consumers and EMTs Resort to Syringes for Severe Allergies,” PBS Newshour, July 6, 2016. LINK
10 “Mylan Launches the First Generic for EpiPen® (Epinephrine Injection, USP) Auto-Injector as an Authorized Generic,” Mylan Press Release, December 16, 2016. LINK
11 “How to Get the Cheaper EpiPen Alternative,” Consumer Reports, August 24, 2016. LINK
12 AUVI-Q website, January 5, 2017. LINK
13 “Teva Says Aims to Launch EpiPen-Like Device by 2018 in U.S.,” Reuters, September 9, 2016. LINK
Note: The information provided here is for reference use only and does not constitute the rendering of legal or other professional advice by McKesson. Readers should consult appropriate professionals for advice and assistance prior to making important decisions regarding their business. McKesson is not advocating any particular program or approach herein. McKesson is not responsible for, nor will it bear any liability for, the content provided herein.