As EpiPen Prices Skyrocket, Nurses Suggesting Patients Use Syringes

[DoGoodThenGo]

Media and now Congress has finally latched onto something many in healthcare have known for quite sometime; EpiPen prices have skyrocketed to $600 from $100 over the past eight years. Families/persons who need these autoinjectors are quite angry because not all can afford the increased rates and worry about being priced out of having access to life saving medication.

According to news reports some nurses and other healthcare professionals are advising patients and or their parents/caregivers to use syringes to inject epinephrine instead. One horrified mother interviewed for local evening news was literally near tears saying she "never could do that" when advised by a nurse who was part of her daughter's medical team. Many EMS personnel have long gone back to syringes as a cost saving measure with the prices of EpiPens putting a strain on budgets.

[applesxoranges, BSN, RN]

One issue is that in my states, EMTs can use an epipen but they cannot draw up epi unless they are a paramedic. I am unsure where the intermediates fall in the spectrum.

Does epi come in vials that are just 0.3 mg 1:1000? You wouldn't want a parent to panic and draw up the entire vial. It would also be better if it came as a kit because otherwise the needle/syringe/vial could get lost whereas a kit it's either all or none.

[RiskManager]

IM Epinephrine Administration by the EMT The “Check and Inject” Pilot Project for the Administration of IM Epinephrine by King County EMTs King County. - Documents This is how it is being done by the EMS system in Seattle and King County.

[marwidog]

I'd rather just get the adrenaclick, now that I know about it. I carry an epipen due to severe peanut allergies. When I go into anaphylaxis, there is no way I could draw up my own dose of epi, even with my training. My hands get shaky and I'm wheezing, if no one is around, I'm screwed. If someone is around who has no idea what they're doing, I'm still screwed. Luckily benadryl has always been there for me and I've never actually had to use my epipen to get me to the hospital. I keep my epipens for 2-3 years to save money since they don't actually expire after the stated one year. I just keep a lot of chewable benadryl around (my house, my car, my locker at work...) it works immediately on my tongue and throat, which keeps me breathing.

[wolf9653]

That's just one brand with a patent. you can get another brand for $40. slight difference in the directions. but if you can learn one, you can learn the other.

[TryVeganToday]

Can't you just preload it, cap it and save it?

[Galveston65]

Epipen is not the only drug to be priced out of sight. I am a diabetic and require Lantus insulin q pm. Since I have been on Lantus a 10ml bottle has gone up from less than $100 a vial to $265 a vial and do not even start on the pens. A box of 5 pens of Lantus goes for $900. I inject per syringe but the company tells everyone that they must discard any unused portion after 28 days even if you keep it refrigerated. At 20U a day that means I have to discard 1/2 a vial every 4 weeks. There is no research to show that discarding the remaining insulin is necessary. I have patients that use the entire vial and have shown no ill effects.

[KatieMI, BSN, MSN, RN]

Can't you just preload it, cap it and save it?

No, you cannot. Adrenaline is chemically unstable drug and standard syringe is too breakable. This is leaving alone problem of dosing.

[carolinapooh, BSN, RN]

You mean one of these?

Looks like pre-drawn epi to me....and folks did just fine with these. :)

[carolinapooh, BSN, RN]

No, you cannot. Adrenaline is chemically unstable drug and standard syringe is too breakable. This is leaving alone problem of dosing.

It would seem the old bee kits were predrawn. Prior to autoinjectors this was the only option. Stuff wasn't always as fancy as it is today.

[carolinapooh, BSN, RN]

Victory of sorts!

Mylan announced today it will produce an authorized generic version of EpiPen that will sell for $300 in a few weeks.

Well bless their little hearts.

[Allgood2016, LPN, LVN]

As someone who has experienced anaphylaxis fringe a bee sting; I am extremely upset and appalled at the price increases. I supposed to carry an Epi-pen with me at all times. Mine expired last month. When I called the manufacturer they told me that my Epi-pens were still good for at least 4 more months. I asked about direct buy and financial assistance. I was told: 1) the cost of direct buy was approximately $200.00 less than at my pharmacy; 2) I make to much money for financial assistance; and, 3) I got told "you're a nurse, just buy epinephrine; and pre-fill syringes and carry them". Needless to say I am still carrying my expired "pens".

As to buying epinephrine and pre-filling syringes... No Thank You!

When are drug manufacturers going to stop increasing prices and lining their pockets?

(Sorry for my rant; but, I needed to.)

[NRSKarenRN, BSN, RN]

WOW Mylan's EpiPen had 3.6 million outpatient prescriptions written last year per article below.

3,600,000 RX X $55.00 profit/unit per CEO = $198,000,000 profit.

From Institute for Safe Medication Practices

What price must we pay for safety? Excessive cost of EPINEPHrine auto-injectors leads to error-prone use of ampuls or vials and unprepared consumers

Recent errors

All of the recent events reported to ISMP involved administration of 1 mg of EPINEPHrine by the IV route after switching from EpiPens to EPINEPHrine ampuls and/or vials. For example, one hospital reported three errors in the past 6 months in which the entire contents of the 1 mg/mL vial of EPINEPHrine was administered IV, when 0.3 mg IM should have been administered. In another hospital, a patient who was experiencing an anaphylactic reaction to FERRLECIT (ferric gluconate) was also given EPINEPHrine 1 mg IV when the correct dose and route was 0.3 mg IM. The patient required admission to a critical care unit for close monitoring....

...Available EPINEPHrine auto-injectors

Mylan's EpiPen is the most frequently prescribed EPINEPHrine auto-injector, generating more than 3.6 million outpatient prescriptions last year.¹ Several rival products joined the market only to fall by the wayside. EpiPen's strongest competitor, Sanofi's AUVI-Q, was removed from the market in October 2015 due to concerns about inaccurate delivery of the dose. A generic EPINEPHrine auto-injector by Impax (labeled as Lineage Therapeutics, which Impax acquired) generated less than 200,000 prescriptions last year,² largely because prescribers are much more familiar with EpiPen. Also, the Impax product cannot be substituted as a therapeutic equivalent for EpiPen because the US Food and Drug Administration (FDA) has determined that there is insufficient data showing that the generic auto-injector is therapeutically equivalent. (The Impax product is not AB rated in the Orange Book.) The Impax auto-injector is not covered by some insurances, and purchasing groups have had difficulty negotiating contracts with the company. Thus, EpiPen essentially has a virtual monopoly on the market, contributing to ongoing price hikes over the years.