EpiPens....who knew?

[roser13]

So, granddaughter #2 turns out to have some fairly significant food allergies. Daughter goes to purchase prescribed EpiPens. Four of them. You must have 2 in order to give a second dose if EMS is slow to arrive. A daycare situation requires 2 more EpiPens.

Walmart Pharmacy calls to inform daughter that the charge for 4 pens is $1200. Daughter says "oh no, I have Aetna insurance." Pharmacy says "that figure includes Aetna's payment of (drumrolll, please) of $2.62." A discount card found on the internet takes another $200 off. Daughter is left to pay $1,000 for a drug she hopes she will never need and which expires in 10-12 months. One of my OR sources quotes the amount of epinephrine in 1 pen as having the base cost of $.03.

Turns out that the maker of EpiPen has a virtual corner on the market on adrenaline pens. Every year, they increase the price because, well, because they can. They have also been accused of artificially decreasing the expiration date in order to require an annual purchase. Making money hand over fist on the backs of sick babies and adults.

There is so much wrong with our healthcare delivery system.

[NOADLS]

And - what if after 2 years you take the epipen you have at home, because the child is having an allergic reaction and you give both syringes but the child dies (G-d forbid). In that case you would feel terrible guilt for the rest of your life, even if the death was not avoidable with a non expired epipen. There would always be second guessing - did I sacrifice life because of $$?

Properly storage is an issue with epipens. you have to be so careful that they do not get too hot or cold.

If you had the expert testimony to conclude that your epi pen would indeed be good for that length of time AND you knew the storage was ideal, there wouldn't be anything to feel bad about. You did your due diligence. You might second guess, but if you did, you wouldn't be the type of thinker who would keep an epi pen past the expiry for logical reasons; you would be the type of person who would keep an epi pen past the expiry to save money. There is a right away to confidently keep an epi pen past expiry and a wrong way. Storage is the big issue. Testimony on the length the pen is useful for is the other big issue. With both, you have a strong argument to keep the pen past expiry. With the absence of either, the argument isn't valid.

All this does not matter to the school nurse who needs to insist on an epipen that is not expired, otherwise the child will not be allowed in school.

This falls into more of a business situation that is harder to avoid. I would expect that an epi pen stored at a school is being stored properly, but despite that, the bureaucracy is going to force you to shell out the money regardless. This is more of a business situation than a personal situation.

[BuckyBadgerRN, ASN, RN]

Patients have ALWAYS complained about the cost!!

Well, of course I knew about EpiPens. I was clueless as to their cost. Unless you have a family member who uses one, or have dealt with patients trying to purchase one, how would you know the outrageous expense?

[abbnurse]

roser13 -

While searching for assistance for a family member who needed a very high-cost medication, I finally found a company called Rxoutreach. They provide many medications at a very reasonable price. There are some income parameters, however, they aren't terribly restrictive ( a family of four, for example, top end income to qualify is $72,900/year).

I checked their website (Rxoutreach.org) and they offer a product called Adrenaclick Epinephrine Auto Injector in two different dosages, price listed is $200 for a two-unit pack.

I hope this helps!

ETA: Having health insurance with prescription coverage does not disqualify you from eligibility.

[nutella, MSN, RN]

If you had the expert testimony to conclude that your epi pen would indeed be good for that length of time AND you knew the storage was ideal, there wouldn't be anything to feel bad about. You did your due diligence. You might second guess, but if you did, you wouldn't be the type of thinker who would keep an epi pen past the expiry for logical reasons; you would be the type of person who would keep an epi pen past the expiry to save money. There is a right away to confidently keep an epi pen past expiry and a wrong way. Storage is the big issue. Testimony on the length the pen is useful for is the other big issue. With both, you have a strong argument to keep the pen past expiry. With the absence of either, the argument isn't valid.

This falls into more of a business situation that is harder to avoid. I would expect that an epi pen stored at a school is being stored properly, but despite that, the bureaucracy is going to force you to shell out the money regardless. This is more of a business situation than a personal situation.

While your attempt to present a logical solution to this situation is admirable you do not take into consideration that your advice is based on the assumption that a person is able to maintain perfect conditions plus logical thinking at all times. Given that we are taking about human beings it is very unlikely to be the case. So it is a hypothetical construct that is flawed.

There will be almost never ideal storage conditions unless you are living in a place with ideal temp and humidity & the person to receive the epipen never leaves that location. As soon as you step outside it is not as perfect anymore...

The school nurse scenario is not a business situation but a situation in which a licensed professional needs to adhere to law, policy and procedure.

What is business is that the pharmaceutical industry has a patent on the unique construction and since there is a huge market, they can increase the amount the ask for and people will pay because they want to live or their family to live. That is a market business decision based on the idea to maximize profit and could be interpreted as greed. Is it ethical to do so? That is a total different question...

What is also a business decision is the fact that more people elect a high deductible plan with the intention of saving money as your monthly premiums are low but your have a high deductible. After you meet the deductible, the insurance pays. People who elect this plan need to ensure that they do have the cash available to pay up front the deductible if things do not go as expected. Because they will have to pay. Unfortunately, people sign up because they feel they can not afford a different plan or just think that they will be fine and not sick. But if you are unlucky, you need to pay and perhaps you thought the a medication is $ and calculated based on that but now it is $$$ ....

[Mom2boysRN]

We buy 2 epi pen 2 packs per year. They are incredibly expensive. It's difficult to always store your epi pens under ideal circumstances between recess at school and sports I know ours aren't always. We've had to use the epi pen on my son twice in the 9 years he has had his food allergy, he has only had two reactions. Both reactions were anaphylactic, the most recent one almost required intubation despite administration of the epi within a minute or so of eating the food that caused the reaction. I will not gamble with my son's life to save money.

[NotAllWhoWandeRN, ASN, RN]

Our pharmaceutical regulation in general leaves a lot to be desired. I saw a lot of problems in my days as a pharmacy tech, and had concerns reinforced when I read a book called Our Daily Meds years back. Manufacturers discovered they could tweak the molecular structure of a med just enough to call it different and get the "new" med patented as the old med's patent was expiring, to keep raking in the brand name profits. A med doesn't have to be better than existing medications to get FDA approval, just needs to be better than placebo. In some cases, like an RLS med (requip?) and mega-income-maker Claritin, marginally better than placebo.

And then you have jackwagons like the guy who raised the price on Daraprim just because he could.

There's a lot of abuse of the system by people who profit from it.

[roser13, ASN, RN]

roser13 -

While searching for assistance for a family member who needed a very high-cost medication, I finally found a company called Rxoutreach. They provide many medications at a very reasonable price. There are some income parameters, however, they aren't terribly restrictive ( a family of four, for example, top end income to qualify is $72,900/year).

I checked their website (Rxoutreach.org) and they offer a product called Adrenaclick Epinephrine Auto Injector in two different dosages, price listed is $200 for a two-unit pack.

I hope this helps!

ETA: Having health insurance with prescription coverage does not disqualify you from eligibility.

Thank you.

[PMFB-RN, RN]

This is something that is being phased out of EMS as well due to cost. We used to carry epi pens but at $400 a pop to us, it wasn't worth it especially since most of the expired. Changed over to $4 vial and syringe. Saves a lot in the end.

When I asked my primary care provider for an Rx for epi pens to keep in my wilderness first aid kit, he just gave me several of the vials & syringes, the same ones we use in the hospital. After he told me how much an epi pen costs I was very greatful.

[stephatron289]

My favorite is when they want a prior authorization for the EpiPen, even though in their chart and medication information it states "Allergy to peanuts, causes anaphlaxis." I have to sit down and compose myself when those come up.

[FurBabyMom, MSN, RN]

My father had an allergic reaction caused by an unknown allergen. He was traveling for work, had to call 911 on himself, was transported to the hospital by EMS and was given epinephrine en route by EMS. He had the type of reaction that got worse again when the first round of drugs started to wear off. I was barely 19 at the time, and had to drive my mother to the hospital my father was in. Somehow, they avoided having to intubate my father. The intensivist discharged my father with a Rx for epi pens. The allergy testing my dad completed showed nothing of the normal allergens causing the reactions. My parents had amazing health insurance at the time, and still paid about $200 every year on that plan for Dad's epi-pens. Now they have switched insurance and put enough on their Flex Spending account to cover the cost of the epi pens.

Oddly enough, I had my own anaphylactic reaction to an unknown agent. I was not given an Rx for epi pens. I am pretty sure that what I was cleaning with cause the reaction, and having never used that product since I've never had a repeat reaction.

[Skeptic-]

My favorite is when they want a prior authorization for the EpiPen, even though in their chart and medication information it states "Allergy to peanuts, causes anaphlaxis." I have to sit down and compose myself when those come up.

Prior auth's are such a load of crap. The doctor prescribed the medication, now they want the same doctor to tell them again, that yes, prescribe the medication. Just another step that probably saves them some small percentage of money from people that give up on that last step. Ugh, I loathe insurance companies.

[TiffyRN, BSN, PhD]

Prior auth's are such a load of crap. The doctor prescribed the medication, now they want the same doctor to tell them again, that yes, prescribe the medication. Just another step that probably saves them some small percentage of money from people that give up on that last step. Ugh, I loathe insurance companies.

I'm one that gave up. Hubbie used Celebrex for arthritis, after call after call and a not so bright office nurse, hubs said to give it up. He just limps sometimes. Yes, insurance won. I have several other stories but they are off-topic.