By: Julia Beatini, Assistant Captain, 2016-2017
Patients and EMS agencies alike seek alternatives for the EpiPen, an epinephrine auto-injector used for treating anaphylaxis, after Mylan pharmaceuticals instated a 500% price increase in 2016. Hopefully, up-and-coming generic auto-injectors will provide a much-needed solution in 2017.
Anaphylaxis is an acute life-threatening allergic reaction that affects millions of people each year. When left untreated, it can result in airway obstruction, respiratory failure, shock, and death. However, epinephrine reverses the progression of anaphylactic reactions by constricting blood vessels and opening airways in the lungs, providing patients with nearly immediate relief. Since the 1980s, epinephrine has been widely available to patients, parents, and emergency healthcare providers in the form of auto-injector pens (1). These small, spring-loaded syringes are pre-filled with a dose of epinephrine that can be injected quickly and easily to stop the progression of an anaphylactic reaction.
The EpiPen®, produced by Mylan pharmaceuticals, was one of the first epinephrine auto-injectors on the market. Since their release in 1987, EpiPens have become the leading epinephrine injectors on the market and have received praise throughout the years for their efficiency and reliability (2). However, Mylan pharmaceuticals recently came under fire after 2016 saw a 500% increase in the price of a two-pack of EpiPen. While the price of an individual EpiPen soared from $60 to over $300, experts estimated that the auto-injectors cost only $30 to produce (3). Following a congressional investigation in the fall of 2016, Mylan agreed to pay the government $465 million to settle claims that the company shortchanged consumers (4). In spite of the outcome of the investigation, patients, parents, schools, and emergency medical providers are still struggling to afford the life-saving medication.
For years, EpiPens have been one of the most commonly administered medications in emergency medicine. According to a 2013 study, more than half of patients who have experienced multiple anaphylactic reactions report “calling an ambulance” as their immediate action plan when experiencing symptoms of anaphylaxis (5). The study also indicated that only a third of patients who have experienced multiple anaphylactic reactions carry EpiPens with them, and this number is likely to decrease as fewer patients are able to afford them. This presents a growing need for EMS agencies to carry EpiPens at a time when many agencies lack sufficient funds to keep the auto-injectors on their ambulances. Although VCEMS will continue to carry EpiPens, many other agencies – especially those situated in small rural areas – are seeking alternatives.
To address the issue, some states are pushing for EMTs to manually administer epinephrine syringes instead of the classic auto-injector. The syringe kits would save districts thousands of dollars, as they cost only $20 (6). However, they also require more time to administer and present a higher risk of infection. States would also need to provide EMTs with extra training in order to administer them safely.
Luckily, different drug companies provide EpiPen alternatives that are steadily gaining popularity. Amedra pharmaceuticals offers Adrenaclick, a pre-filled auto-injector priced at $140 for a two-pack (7). Adamis pharmaceuticals and Windgap Medical are also working hard to get their own auto-injectors on the market. They claim that their products will have longer shelf lives than EpiPens, which must be replaced after one year without use, and that they will be available for roughly half of the current market price of an EpiPen (8). Their products are still pending FDA approval, but are set to be released in 2017. CVS pharmacy also plans to release a generic EpiPen alternative later this year, priced at $110 per two-pack (9).
With the growing number of EpiPen alternatives, individual consumers and EMS agencies will continue to carry epinephrine to treat anaphylaxis. However, the new drug options are certain to change the epinephrine market as we know it, ending Mylan’s long-held monopoly on the industry.