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Maine Doctor Finds Solution to High EpiPen Costs: Cheap Refills

$300 auto-injector delivers less than a dollar’s worth of epinephrine

The concern over soaring prescription drug prices continues to dominate headlines, attracting scrutiny from Capitol Hill and President Donald Trump, who said during a January press conference that the industry was “getting away with murder.” But some doctors—frustrated by what they see as unreasonable price tags and political stagnation—are coming up with do-it-yourself solutions, according to a report from Kaiser Health News. One example is the response of Dr. Cathleen London, a family doctor in Milbridge, Maine, to news that Mylan had boosted the price of its signature EpiPen, a branded auto-injector containing a preset dose of epinephrine.

London helps her patients sidestep the costs of an EpiPen by purchasing reusable auto-injectors manufactured by the British company Own Mumford. The type of auto-injector that she settled on is generally marketed for use with insulin syringes but can be used for many medications. London fills it with epinephrine herself. (Both the auto-injector and the hormone are approved by the FDA.) Patients can present for an epinephrine refill after they have used the dose or after it has expired.

“It’s just a no-brainer to do this,” London said.

The price of EpiPens has surged in recent years—an increase connected to the device, not to the active ingredient, epinephrine, which costs pennies. A two-pack now costs more than $600––up from just over $100 in 2009. In response to public outcries and lawmaker scrutiny, Mylan last December released its own generic version of the device at about half the price, but that’s still out of reach for many patients.

Mylan has pointed out that the EpiPen is designed specifically to administer epinephrine quickly and properly in an emergency situation and has quoted the FDA in saying that the “device that delivers the medication is just as critical.” Nevertheless, critics say that doesn’t justify the skyrocketing price for a device that has remained unchanged for years.

Meanwhile, some insurers have dropped coverage of the pricey name-brand auto-injector pack or have ensured that customers have access to cost-effective alternatives. Drugstore chain CVS reduced the price of a generic competitor––but all still cost at least $109.

Experts say there is no easy way to calculate what is spent annually on EpiPens that are thrown away because they are past their expiration date. Given the product’s price tag, it is likely many millions of dollars.

Other health professionals and government health agencies have employed strategies to deal with the EpiPen’s escalating price tag. In at least a dozen states, pilot programs are either under way or being explored for emergency medical technicians (EMTs) to replace the EpiPens they carry with reusable syringes kits.

For example, participating EMTs in New York City are given syringes that can be filled with epinephrine on the spot. Analysts estimate that between $6 million and $10 million is spent annually by the state’s first responders on EpiPens “that are generally never used,” said Dr. Jeremy Cushman, an associate professor of emergency medicine at the University of Rochester, who is leading the New York effort. Using refillable syringes, he said, the total expense per year is less than $400,000.

Some institutions, such as school systems, have been slower to consider this and other replacement options, partly because they have less incentive to do so. At least 11 states require that schools keep epinephrine on hand, and schools often receive EpiPens from the manufacturer at steep discounts or free.

Sources: Kaiser Health News; March 1, 2017; and The New York Times; February 28, 2017.

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