The EpiPen that cost $75 in 2001 costs over $300 today

[Magpie]

I've personally seen a anaphylaxis kit that included a traditional locked hypodermic needle as well as other items. This existed alongside the EpiPen. It had more steps, but it didn't require measuring the dose. More common usage of the EpiPen seems to have resulted in this going off the market. I think the EpiPen was also price competitive back in the early 90s.

True... I was thinking further back.

Actually, I've been looking up rescue treatments for asthma, and Epipen really was revolutionary.

Epinephrine was first discovered around the turn of the century. Needles and syringes came into use around 1909, and were greatly appreciated, as before that doctors and nurses would have to sterilize water to mix up the medication and measure the dose individually. It took time. Although, it doesn't seem that people would have made it to the the doctor in severe cases anyway. Most folks tried to treat attacks at home, using powders, incense, even something called "asthma cigarettes", and would only go to the doctor if they couldn't get relief any other way.

Nebulizers, using adrenaline, could be purchased in the 1930's for home use... but you couldn't exactly walk around with one, or take it to school. Syringes are also very hard for people to use, especially if they're struggling to breathe.

The Epipen was introduced in the '70s and was so simple to use that even a child in crisis could treat themselves. It saved countless lives.

I used to think the worst thing we could do was force kids to keep their Epipens locked in a school nurse's cabinet (a boy in Canada died a few years back because he couldn't get to his pen quickly enough). Now I think the greatest crime is allowing companies to jack up the prices to the point where people can't even afford to carry one.

 

[PollyannaMom]

I used to think the worst thing we could do was force kids to keep their Epipens locked in a school nurse's cabinet (a boy in Canada died a few years back because he couldn't get to his pen quickly enough). Now I think the greatest crime is allowing companies to jack up the prices to the point where people can't even afford to carry one.

I agree with you on both counts!

And your other post, too:

The simplest answer: They died....Your death might be attributed to allergies, or your family might think you just choked, were poisoned, or got sick....

(I "liked" it because I thought you were right, not because I actually liked the answer, of course!)

 

[bcla]

I have no dog in this fight but what did people do before the epi-pen?

Antihistamines I guess. They were included in anaphylaxis kits. I know they're not a substitute for epinephrine, but I've talked to people who had doctors recommend they take some if there was no other option. I even heard of someone who took a megadose (maybe 15 mg) because he discussed this previously with his doctor. Of course this is something that was discussed with a medical professional, so of course anyone who is thinking of this needs to talk it over.

 

[bcla]

Here's one doctor who is recommending the vial and needle as an alternative. I'm not sure about recommendation for a container. It seems too small for the standard 3 ml syringes; insulin syringes are shorter. Another issue is that kids aren't typically allowed to carry needles to school. However, school nurses have been known to administer insulin.

http://www.daytondailynews.com/news/news/local-health-network-suggests-epipen-alternatives/nsL9t/

Local doctors are offering alternatives for families who cannot afford to pay up to $600 or more for the auto-injectors. Kettering Health Network, a local health care provider, offers an alternative it says is “just as effective.”

Dr. Marcus Romanello, chief medical officer for Fort Hamilton Hospital, said patients can get a vial of epinephrine at a pharmacy and store it in a small container. He said users still need to have a prescription to obtain the drug.

 

[Tuffcookie]

For what it is worth, I went to Mylan's website and sent an e-mail. I told them, although releasing a generic form of the Epi pen is a step in the right direction, the cost of the generic is still too high for the average consumer.

TC

 

[kellyjeanie]

Here's another argument against using the epinephrine with syringe method as an alternative to the EpiPen. It just doesn't seem like a good idea. My son has a peanut allergy and I can't imagine having to fumble with a syringe and vial, even with proper training, while my child struggles to breathe.

(link includes salty language)
http://www.scibabe.com/epipen/

 

[robinb]

Here's another argument against using the epinephrine with syringe method as an alternative to the EpiPen. It just doesn't seem like a good idea. My son has a peanut allergy and I can't imagine having to fumble with a syringe and vial, even with proper training, while my child struggles to breathe.

(link includes salty language)
http://www.scibabe.com/epipen/

I think that parents are capable of doing many things for the life of their children that they did not think possible. Don't sell yourself short.

 

[bcla]

Here's another argument against using the epinephrine with syringe method as an alternative to the EpiPen. It just doesn't seem like a good idea. My son has a peanut allergy and I can't imagine having to fumble with a syringe and vial, even with proper training, while my child struggles to breathe.

(link includes salty language)
http://www.scibabe.com/epipen/

I don't think it's all that bad, but the hope is that it doesn't have to be done on the spot. Quite a few of the recommendations from medical professionals are to draw 0.3 ml ahead of time and place it in a safe place in the house and replace after 3 months (3 seems to be the magic number). If I were asked to do that in a no stress situation, I'm pretty sure I could get it reasonably close. For travel it's a bit more difficult to keep a syringe from losing its contents. Having some sort of seal to break with the plunger seems to be the key.

The injection is the easy part. It's the worry about overdose or spilling the drug that's the hard part. If Adamis can get its pre-filled epinephrine syringe on the market, the publicity around Mylan could be the best thing for their ability to sell it.

http://seekingalpha.com/news/320563...proval-looming-epinephrine-pre-filled-syringe

 

[bcla]

The article mentions that the "generic" will be functionally identical.

The main issue here isn't about the drug, which has been generic since before any auto injectors were ever made. The issue is the delivery mechanism, which is in part patented. It's pretty much a regulatory and prescribing issue. It's a regulatory issue when competitors have been pulled off the market and when potential competitors have had their versions denied approval. There is actually one competitor with limited availability. Some have mentioned that most states won't allow substitution without approval of the prescriber.

The odd thing is that it's unclear who makes them. Mylan doesn't even own it, and there have been some claims that they make them under license or that a division of Pfizer makes them. It's a contract issue involving marketing rights. Pfizer actually holds the ultimate rights.

OK, I had a good look at one of the hundreds of images of the EpiPen, and it clearly says who makes it. Mylan does not, and the actual manufacturer (Meridien, owned by Pfizer) is right there on the label. I'm wondering if Pfizer might possibly have veto rights regarding this attempt to produce a "generic" since their division will be making it.

I got confused by a lot of the claims and counterclaims about who makes it.

 

[Dawnlight]

We are epi-pen consumers due to one son's sting allergy. Fortunately, ours is covered by insurance with a small co-pay, which is covered directly by my husbands company. I should print out the coupon to use to have the co-pay covered by Mylan instead. I wasn't aware of how expensive the medication has become over the years; that's just awful, but I'm not so surprised considering the exorbitant costs of other medications and treatments.

Our family rarely goes to our doctor as we are generally very healthy. The last time I was there was due to a very bad reaction to poison ivy with one of my children. We saw some of the charges due to the two visits (one initial one, prescribed topical steroid, which didn't do anything and a second visit for prescription of oral steroids and lancing of a huge blister). Do you know how much was charge for lancing a blister on one finger? $250!!!!! Yes, $250 for the 2 minutes (or less) to lance the blister and another ridiculous amount that I don't remember for the sterile kit (what looked like a tiny razor blade). Next time? I'll be boiling a needle and taking care of it myself. It's ridiculous. Yes, we only paid the co-pay, but others that are either uninsured or under-insured have to deal with similar costs.

I do think it's somewhat related to ACA in that these companies feel that since a certain portion of people will be 100% covered and never will see the actual costs, they can inflate them to great profit. It's no different than dentists telling patients on state health care plans where dental is fully covered that their children need unnecessary treatments because no one will question it since it's no cost to them.

 

[mnrose]

We are epi-pen consumers due to one son's sting allergy. Fortunately, ours is covered by insurance with a small co-pay, which is covered directly by my husbands company. I should print out the coupon to use to have the co-pay covered by Mylan instead. I wasn't aware of how expensive the medication has become over the years; that's just awful, but I'm not so surprised considering the exorbitant costs of other medications and treatments.

Our family rarely goes to our doctor as we are generally very healthy. The last time I was there was due to a very bad reaction to poison ivy with one of my children. We saw some of the charges due to the two visits (one initial one, prescribed topical steroid, which didn't do anything and a second visit for prescription of oral steroids and lancing of a huge blister). Do you know how much was charge for lancing a blister on one finger? $250!!!!! Yes, $250 for the 2 minutes (or less) to lance the blister and another ridiculous amount that I don't remember for the sterile kit (what looked like a tiny razor blade). Next time? I'll be boiling a needle and taking care of it myself. It's ridiculous. Yes, we only paid the co-pay, but others that are either uninsured or under-insured have to deal with similar costs.

I do think it's somewhat related to ACA in that these companies feel that since a certain portion of people will be 100% covered and never will see the actual costs, they can inflate them to great profit. It's no different than dentists telling patients on state health care plans where dental is fully covered that their children need unnecessary treatments because no one will question it since it's no cost to them.

A HUGE failure of the ACA is that it failed to address negotiated power for drugs. Medicare is NOT allowed to negotiate for drug prices at all, which is absurd. It was a "gift" to big Pharma for their support. And, why wouldn't they? Their profits can become even more obscene now.

 

[mom2rtk]

We are epi-pen consumers due to one son's sting allergy. Fortunately, ours is covered by insurance with a small co-pay, which is covered directly by my husbands company. I should print out the coupon to use to have the co-pay covered by Mylan instead. I wasn't aware of how expensive the medication has become over the years; that's just awful, but I'm not so surprised considering the exorbitant costs of other medications and treatments.

Our family rarely goes to our doctor as we are generally very healthy. The last time I was there was due to a very bad reaction to poison ivy with one of my children. We saw some of the charges due to the two visits (one initial one, prescribed topical steroid, which didn't do anything and a second visit for prescription of oral steroids and lancing of a huge blister). Do you know how much was charge for lancing a blister on one finger? $250!!!!! Yes, $250 for the 2 minutes (or less) to lance the blister and another ridiculous amount that I don't remember for the sterile kit (what looked like a tiny razor blade). Next time? I'll be boiling a needle and taking care of it myself. It's ridiculous. Yes, we only paid the co-pay, but others that are either uninsured or under-insured have to deal with similar costs.

I do think it's somewhat related to ACA in that these companies feel that since a certain portion of people will be 100% covered and never will see the actual costs, they can inflate them to great profit. It's no different than dentists telling patients on state health care plans where dental is fully covered that their children need unnecessary treatments because no one will question it since it's no cost to them.

I would lay money there's an exclusion on that coupon for purchases that involve a third-party payor.

And many of us with high deductible plans are already finding ways to doctor at home. We're thankfully a pretty healthy family, but have had several instances of making hard decisions with different choices than we would not have made even a couple years ago when we had better protections in our plans (like known copayment costs instead of open ended high dollar deductibles).

 

[bcla]

I would lay money there's an exclusion on that coupon for purchases that involve a third-party payor.

And many of us with high deductible plans are already finding ways to doctor at home. We're thankfully a pretty healthy family, but have had several instances of making hard decisions with different choices than we would not have made even a couple years ago when we had better protections in our plans (like known copayment costs instead of open ended high dollar deductibles).

Actually it's targeted at third party payers. It's supposed to cover everything up to what would be the out of pocket costs, up to the co-pay. However, it doesn't apply to someone with government paid insurance like Medicaid. They don't directly reimburse the patient. It goes to the pharmacy to cover the co-pay.

https://www.epipen.com/copay-offer/

 

[bcla]

So there is the news about the "authorized generic" which will be identical except for the label. Some people don't get what this is supposed to do. The list price will be lower, but who knows what the final cost will be. On top of that, because it's legally a generic, the states that don't allow an easy substitute will require that a pharmacy contact the prescriber to authorize the switch.

http://www.businessinsider.com/myla...zed-generic-epipen-is-confusing-people-2016-8

I do remember stuff like this when I was wearing contact lenses. There was a series of contact lenses with the "BioMedics" brand made by a company called Ocular Sciences. When I got my initial fittings, that's what the eye doc gave me. When I purchased several boxes of lenses, they came with the "ProFlex" private label brand name. The address of the manufacturer was the same, but listed a different name. The eye doc said they were identical, but the prescription she wrote could only apply to the private label brand. She also said that if I wanted it, I she would write up a prescription for the brand name. Apparently the exact same lens was sold under different names like UltraFlex, AquaLite, and even store brands like Target.

 

[mom2rtk]

Actually it's targeted at third party payers. It's supposed to cover everything up to what would be the out of pocket costs, up to the co-pay. However, it doesn't apply to someone with government paid insurance like Medicaid. They don't directly reimburse the patient. It goes to the pharmacy to cover the co-pay.

https://www.epipen.com/copay-offer/

But that's actually my point. The PP with a small copay would not be able to use it to diminish what her insurance company had to pay for it, only her own costs.

 

[bcla]

But that's actually my point. The PP with a small copay would not be able to use it to diminish what her insurance company had to pay for it, only her own costs.

It's a real mess because no insurer pays the same price. In many ways, the list price is designed as a negotiation point. However, people with poor or no insurance are paying near full list. The pricing was a ploy, and some patients are paying high prices as a result.

 

[Pea-n-Me]

I saw some interesting articles last night, as more people/groups are getting involved with this.

http://www.ipwatchdog.com/2016/08/29/government-blame-price-epipens-patents/id=72412/

http://www.mlive.com/news/kalamazoo/index.ssf/2016/08/what_the_experts_say_about_fiv.html

http://www.aappublications.org/news/2016/08/26/EpiPen082616

 

[bcla]

Of course there's one company that is revisiting the traditional syringe. The last I heard of the old "Ana-Kit" was that several were recalled because the epinephrine may not have been potent enough, although there's no word on how that happened (maybe the drug was too old?), and that was in 1999. I can't find out how long ago it was finally discontinued. I believe Bayer owned the company that made it.

I found one good picture though.

It's got all the stuff I remember from the classroom presentation. There's the "tourniquet", the antihistamine tablets, alcohol prep pads, and the hypodermic needle. The plunger unlocked by twisting it, and the needle was covered with a rubber sheath. I read some more that it had two doses, where each dose required a twist before the plunger would move. It also had a total of 1 ml, but was only designed to deliver two 0.3 ml doses.

 

[bcla]

https://www.wildmed.com/blog/discussion-on-epi-pen-prescription-increase/

“Hollister-stier drug company, the original developer of the Anakit and Anaguard injectable 1:1000 epinephrine solution has recieved FDA approval for a replacement epinephrine product to be called Twinject (for the two doses in the syringe). Many outdoor programs used the Anakit or Anaguard product for treating anaphyllaxis or severe asthma. The company discontinued the product in 2001 after their supplier of epinephrine (Wyeth Pharmaceuticals) ran into financial problems and stopped producing the epinephrine solution. Since Hollister-stier did not make the drug (only packaged it in the Anaguard syringe) they did not have FDA approval to produce the actual drug, only to produce the syringe.

The company submitted an application for their own production version of the epinephrine solution. FDA approval was granted in July and the company plans to begin production of the Twinject unit in the spring of 2004.”

The Twinject and Anakit rights were bought and obtained by Versus Pharmaceuticals in 2006 in the US and produced in Canada by Paladin Labs. Since they own both patents, it may be hard to get them to produce Anakits again.​

Doesn't make that much sense. I would think there were numerous manufacturers of epinephrine, and they're all made to USP standards. Twinject was taken off the market years ago.

 

[Pea-n-Me]

Of course there's one company that is revisiting the traditional syringe. The last I heard of the old "Ana-Kit" was that several were recalled because the epinephrine may not have been potent enough, although there's no word on how that happened (maybe the drug was too old?), and that was in 1999. I can't find out how long ago it was finally discontinued. I believe Bayer owned the company that made it.

I found one good picture though.

It's got all the stuff I remember from the classroom presentation. There's the "tourniquet", the antihistamine tablets, alcohol prep pads, and the hypodermic needle. The plunger unlocked by twisting it, and the needle was covered with a rubber sheath. I read some more that it had two doses, where each dose required a twist before the plunger would move. It also had a total of 1 ml, but was only designed to deliver two 0.3 ml doses.

This looks very old, but it does have an auto-injector, with, presumably, the correct dosage, so no fumbling around with dosages or vials, thankfully.

There would be no need for a tourniquet as one would not be injecting it intravenously. (We cannot make that mistake people!) It is given intramuscularly as a direct injection.

I read a bunch of articles last night and I think I saw just one that mentioned the possibility of a vial, but even that one acknowledged that dosing errors, as well as fumbling in an emergency, could make that method a hazard. Most calls for reform from from professional groups call for an auto injector with a measured dose.