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.

[Spidey's mom, ADN, BSN, RN]

Insurance companies are weird. Sometimes this kind of thing is ok and sometimes not.

It should truly be what the physician thinks is the best medication for the patient - and let's face it, epinephrine isn't a brand new drug and very expensive to manufacture.

My last sentence is bugging me . . . I meant to say that epi isn't a brand new drug and also isn't very expensive to manufacture.

New drugs on the market are priced high at first. Epi is an older drug.

(Sorry - I'm just peculiar about spelling, grammar, unclear sentences).

[T-Bird78]

Thousands of insulin dependent diabetics, even children, do it everyday.

EpiPens are important but in reality the alternative is the daily ritual for thousands of others.

Yeah, but insulin is subcu, whereas epi is IM--big difference in administration. It's much easier to self-inject subcu than IM. I have done both to myself, subcu for my zofran pump and IM for a steroid shot, and the average layperson couldn't safely do IM. I have administered IM epi from a multi-dose vial and have demonstrated EpiPen use to hundreds of pts, and it's much easier and nearly fool-proof for laypersons.

There is a generic epinepherine auto self-injector available, but the good folks at EpiPen are quick to say that it has not been proven as effective as EpiPen. They manged to run off TwinJect (although I hated how their second dose was administered) and run off Auvi-Q. Hmm. . .

EpiPen has a high copay regardless of what your prescription deductible is. It's at least $150 and I have had pts tell me they can't afford it (I worked in allergy/asthma where we rx epi and administer all the time).

Prior Auths really are terrible. The insurance is telling doctors what they can and can't write. You have to try drug X, drug Y, drug Z, and two OTC meds before they'll cover the rx, and then it's nonformulary so it's a higher copay.

[roser13, ASN, RN]

I work in an allergy practice and we have coupons from Mylan that will cover the entire cost of up to 2 two packs of Epi-pens and are good for as many refills as needed for 1 year. We've had these coupons for the last 3 years. They are only valid for patients with commercial insurance, but Mylan is great about giving us samples so those who cannot afford the cost can get a pack.

Are these coupons not available nation wide?

My daughter spoke with 3 different Mylan reps. They offered nothing. No discount, no freebies, no advice. On the whole they were rather blasé about the while thing. It wasn't until the 3rd Walmart pharmacist that she found someone willing to stretch a little & help her look for alternatives.

[DanidelionRN, BSN, RN]

To the person saying "maybe arcane rules at schools like having to abide by manufacturers expiration dates is why homeschooling exploded in the last few decades".......

As a homeschooled graduate, I would say no. The rule males sense for liability purposes and anyone with a logical brain who has any hope of homeschooling their children successfully, can understand why the rules would be in place. Homeschooling skyrocketed because a:there is great curriculum out there now, where there wasn't as much before; b: test results confirm that homeschooled students on average score better than their public school counterparts, c: parents have a desire to individually tailor their child's education to enhance learning by focusing on their strengths and weaknesses, and individual attention rather than being 1in 30; d: you get to control what kind of experience your child has with the less savory side of the public, a bit more. No bullying, abuse by teachers or peers, intense peer pressure, pressure to be popular, etc.... because your child learns to encounter the world on his or her own terms, because they have a sense of who they are for themselves, without needing to"be like" someone else, or fit some mold. e: you get control over WHAT is taught, and how it is done. Maybe you don't like the "new" math? Teach it the"old" way. You want to go on a road trip for a month in autumn? School can go with you, and you can also schedule lesson plans to accommodate the schedule you want. Maybe you don't think your five year old needs exposure to what homosexuality or sex are, yet, or want to provide age appropriate information based on your child, and the values you want to instill in them.

Homeschooling lets you do those things while providing a child with an excellent education and a love of learning that benefits them for life. It has very little to do with not liking school rules related to safety.

[wolf9653]

can't be much harder than giving glucagon as an emergency measure IM to a diabetic.

Yeah, but insulin is subcu, whereas epi is IM--big difference in administration. It's much easier to self-inject subcu than IM. I have done both to myself, subcu for my zofran pump and IM for a steroid shot, and the average layperson couldn't safely do IM. I have administered IM epi from a multi-dose vial and have demonstrated EpiPen use to hundreds of pts, and it's much easier and nearly fool-proof for laypersons.

There is a generic epinepherine auto self-injector available, but the good folks at EpiPen are quick to say that it has not been proven as effective as EpiPen. They manged to run off TwinJect (although I hated how their second dose was administered) and run off Auvi-Q. Hmm. . .

EpiPen has a high copay regardless of what your prescription deductible is. It's at least $150 and I have had pts tell me they can't afford it (I worked in allergy/asthma where we rx epi and administer all the time).

Prior Auths really are terrible. The insurance is telling doctors what they can and can't write. You have to try drug X, drug Y, drug Z, and two OTC meds before they'll cover the rx, and then it's nonformulary so it's a higher copay.

[BCgradnurse, MSN, RN, NP]

My daughter spoke with 3 different Mylan reps. They offered nothing. No discount, no freebies, no advice. On the whole they were rather blasé about the while thing. It wasn't until the 3rd Walmart pharmacist that she found someone willing to stretch a little & help her look for alternatives.

Are you kidding me?? That's not right. I'm going to talk to my rep next time she's in. That's just crazy.

[KelRN215, BSN, RN]

People see a false sense of economy sometimes taking out a cheaper plan, with a high deductable. In which case they have noone to complain about but the guy in the mirror.

The author of this article states that her husband's employer only offered high deductible plans. That happened to me last year. When I change jobs, I always ask about the health insurance options. I turned down a job last year because they only offered tiered or high deductible plans. Then this year, the company I did accept a job with (and had very good insurance through last year) eliminated all the platinum plans from their benefits package. I cried for 2 weeks about this knowing what it meant for me with my medical history. The plan I am stuck with has a $2K deductible followed by a 20% coinsurance until a $5K out of pocket max is reached. I met my deductible by April. My flexible spending account- with the max contribution the federal government allows- has $38 left in it. I paid $2100 for an MRI this year that cost me $0 with a platinum plan last year. It's not always the patient looking for a cheap option, sometimes it's the employer cutting corners and leaving you with no other option. And, when you're in a precarious medical situation, changing jobs for better insurance isn't always an option because then you're not eligible for FMLA for another year, so what are you to do if your situation gets worse?

[RiskManager]

EpiPens cost so much people are using riskier DIY alternatives - Business Insider

I just read this on-point article on Business Insider. The EMS community is moving away from the EpiPens and to a vial and syringe for all the reasons mentioned here. From a liability perspective though, I suspect that schools, camps and other institutions will continue to insist on an EpiPen since it is more error-proof.

[NutmeggeRN, 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.

Well, for us peons who are clearly not as knowledgeable as you, we CANNOT keep an epi pen in our health office past its expiration date.

This was shared on a SCHOOL NURSE FORUM , Maybe you should stick to whatever your specialty is an impart your wisdom and knowledge there...

[mmgRN]

Wow-OUCH!

I paid $450 for a set of two, (insurance covered $0, found a coupon for $100 off).

I researched it to see how they were still trademarking adrenaline and charging a fortune, as it is not new, they trademark the delivery device. Basically, you're paying a fortune for a plastic device that auto injects.

What is so sad is that most families HAVE to buy two sets, for us that means $900 per annually (with insurance, we have united health choice plus and it does not cover EpiPens at all, TG for coupons). I am super thankful that we are able to afford the pens, but can't imagine what those families do that can't. It's not like you can go without it!

Something so basically lifesaving, in my opinion should at least be covered by all insurance, or at least made affordable!

[mmgRN]

I've asked for epi junior in a generic form, but have yet to find one available. I will research this more for sure!

[bathrobemom, LPN]

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.

Epi Pens need to be stored between 68 degrees and 77 degrees. I think we're all smart enough to know that you can probably go a few degrees either way beyond that, but how can you look at that narrow temperature range and think that would be easy to maintain? I live in the Midwest, temps can regularly be 0 to 30 in winter and 80 or higher in summer.

You do realize there is no daily medicine (Zantac, Pepcid, etc do nothing against my food allergies), no treatment, no surgery, to treat food allergies? All you get is an Epi Pen. Three meals a day you need to check that your food is safe to eat. Three times a day for the rest of your life and there's only one medication that can help you.

When my Epi Pens pass their expiration date, I buy new ones. It's the only medication I have to save my life, so I don't follow anecdotes on the Internet and hope for the best when I have an anaphylactic reaction.