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.

[lavenderskies, BSN]

Do your research on how long these things actually last when stored properly. If your use for them is personal and not business related, you can get away with holding onto an expired one.

Yes the costs are ridiculous, but you don't need to be shelling out money every year like a sheep. You've described a situation where a logical thinker can arrive at a reasonable answer. Sometimes I think I should be charging money for offering logical advice, but I am happy to do it for free hoping that I can inject some common sense into the general population.

Even if they held onto expired ones longer for home use....the school would still need unexpired ones.

[Skeptic-]

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.

That's too bad, I'm sure it's all too common too.

Off topic, when I read the email just now that I had a response, I thought you were my wife responding. Her name is Tiffany, I call her Tiffy often, she is an RN BSN as well, haha.

[stephatron289]

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.

They drive me crazy. It's even harder when a patient is new to our clinic and has been on a specific medication but needs a renewed prior authorization and we have no paperwork on them

[BeachsideRN, ASN]

Wowser. Last time I bought one my insurance covered on high true $50. Maybe she needs a pre auth or special coding for it. I would call the insurance company.

[BeachsideRN, ASN]

Check goodrx.com too they usually have better prices (about $600 for a pack of 2, then you should be able to use the $200 coupon also). That really blows. I guess with auviQ out of the way epi pen is back to being the only game in town. Also due to the nature of the med I feel like if you don't use it by expiration date you should be able to return it to manufacturer at least for a credit if not free/cheap replacement.

[azhiker96, BSN, RN]

You might consider a generic auto-injector. Looks like it's just under $140 for a two pack at Walmart.

Epinephrine Prices and Epinephrine Coupons - GoodRx

[NotAllWhoWandeRN, ASN, RN]

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.

In some cases, sure, but things also get stalled when doctor's prescribe a new fad drug that costs 10 times as much and is isn't any more effective. That's not the insurance company being greedy, it's the doctor being ignorant. I saw a doc prescribe a Medicaid patient Lexapro (escitalopram) instead of Celexa (citalopram) when Lexapro was brand only, and Medicaid didn't cover brand names without a specific reason. That was the doctor's fault, not the insurance's. Most people don't have Medicaid, but I saw that same type of problem over and over again during my years as a pharmacy tech.

[NuGuyNurse2b]

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...

You mean the same thing would happen with an epi pen that's within its expiry time-frame if stepping outside into a different environment than your home would be that much of a difference to render the epi useless? Are we stepping outside to Dante's Inferno or something? And maintaining an ideal storage condition for an epi isn't that impossible, you're just trying to make it seem like it is to fit your argument.

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.

Which is a business situation vs a personal situation. You are taking the "business" part too literal and thinking suits, briefcases, etc.

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 $$$ ....

Um...that goes back to the "due diligence" part that NOADLS is talking about. Research your epi's, and maybe if you are in a situation that requires you to buy them, do your research on your insurance premium and oh I don't know, don't buy the high deductible one? You can't force big pharm to change their ways. And I really wish people would stop painting big pharm as some kind of evil industrial entity. They spend millions on research and need to recoup that money somehow. target the insurance companies who put out these high deductible/low premium policies to attract cash strapped consumers who essentially paid for something that does nothing for them when they need it the most.

[roser13, ASN, RN]

You might consider a generic auto-injector. Looks like it's just under $140 for a two pack at Walmart.

Epinephrine Prices and Epinephrine Coupons - GoodRx

That looks amazing! I sent the link along to my daughter. Thank you!

[Extra Pickles]

Do your research on how long these things actually last when stored properly. If your use for them is personal and not business related, you can get away with holding onto an expired one.

Yes the costs are ridiculous, but you don't need to be shelling out money every year like a sheep. You've described a situation where a logical thinker can arrive at a reasonable answer. Sometimes I think I should be charging money for offering logical advice, but I am happy to do it for free hoping that I can inject some common sense into the general population.

I'd have to return your logical advice for a refund, lol as it has no value when it comes to school policies!

I had to have an epi-pen available at my child's school and also one for the bus driver. I remember it was expensive but not this crazy. But once the expiration date was reached, the school would insist on a new pen for the nurse's office and the bus. It wasn't up to me to hang onto it for longer, logical or not. I was forced to buy two every year until it was no longer needed. So sorry but no common sense injection available ;-)

[fulitarn, BSN, RN]

They are absurdly expensive. My insurance fortunately only requires a $100 co-pay for the set of two. So I have to get one for me, and one for my sister, who doesn't have insurance but has an even worse shellfish allergy than mine.

[Asystole RN]

Mylan pretty much created the epinephrine auto-injector market and awareness, not unlike how Listerine developed the oral care market around halitosis. They are not however the only source for auto injectors as many have pointed out.

It is unfortunate how expensive EpiPens are but now that every other company is seeing how much can be made from it we are seeing many other competitors, even Teva is jumping into the game. Sanofi's recall of Auvi-Q is testimony to what a high-stakes game pharma can be.

My company used to have a pharmaceutical division but sold it off years ago despite it being one of the most profitable. The sales cycle from R&D to on the shelves was literally about 10-15 years. That is a long time to invest, not to mention the money invested, to start seeing a return. Those returns were exceptionally high but took a long time and were very risky, like what Sanofi is finding out.

The person behind EpiPen is the person behind why we see defibs everywhere now too.