Wednesday, September 16, 2009

Generic Alternative to EpiPen and TwinJect? Not Exactly...

On Sept. 16, 2009, Adamis Pharmaceuticals Corporation announced that Walgreens will begin to offer its epinephrine pre-filled syringes (Epi PFS) as a generic alternative to epinephrine autoinjectors.

Certainly, it is wonderful to have a lower-cost alternative to EpiPen and TwinJect. (Tier 1 co-pay on Aetna and Cigna!) Many parents cough up $70 or more out of pocket for epinephrine autoinjectors that end up being thrown away. Now, don't get me wrong- I think it's much better to spend the money and throw it away than not spend it and be without life-saving medication if you should need it. But when you need one for home, one for school, one for grandma's house, etc... it adds up.

On top of that, I like to prescribe epinephrine for my immunotherapy patients, and they aren't thrilled about the co-pay either, especially when the prescription is only a precaution.

However, just because the medication inside the syringe is the same doesn't mean that device is equivalent to the branded drug. The beauty of epinephrine autoinjectors is just that- they auto-inject. You don't see the needle until it comes out of your leg, the risk of sticking yourself is lower, and the risk of accidentaly squirting your life-saving medication into the air is lower as well. Try as I might, I cannot find a photograph of Adamis's epinephrine "PFS". Their website doesn't describe the product/device, except to state that "While an extremely important piece of Adamis Labs’ product development strategy, Epi PFS serves as an introduction for the commercialization identity, and as a precursor, to its more long-term and higher potential revenue generating products."

Hmmm... Sorry, Adamis Pharma. Your public statements do very little to convince me that you really care about making a quality alternative to the existing market leader. It's possible that your product may have promise for adult patients who are unlikely to actually need it. However, until I can get my hands on your device and feel confident that it is both easy and safe for my patients and parents to use, my prescriptions will continue to be marked, "Dispense As Written".

23 comments:

  1. Hi Dr. Bajowala,
    Do you know if people whose insurance requires them to use the generic unless otherwise specified will be automatically switched to this new dispenser?
    Laurie Tarkan
    twitter.com/isitallergy

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  2. Because Epi PFS has been classified as a generic alternative, there is a distinct possibility that it may be substituted at the pharmacy. Pharmacies generally make a larger profit on generics than they do on branded drugs, so the pharmacy will be interested in pushing the generic alternative. Be aware, and if you are not comfortable with the syringe device, ask your physician to specify "Dispense As Written".

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  3. My doctor has prescribed an Epi-Pen for my daughter who is mildly allergic to cat and dog dander. In my opinion, it is a total waste of money. You're talking about $60 for me to get something which will never be used. I don't plan to do so and am currently looking for another physician.

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  4. I generally only prescribe epinephrine autoinjectors when I believe there is a risk of a serious systemic allergic reaction. Without knowing your child's medical history, it is impossible for me to comment on the appropriateness of her EpiPen prescription, but I do believe the device and drug are invaluable in the right scenario.

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  5. I am a physician who recently arrested due to a wasp anaphylaxis. Epipen is unobtainable in my neck of the woods, and if it is even more expensive. I carry a predrawn up 2ml syringe with epinephrine in a rigid toothbrush case. It even has space for an extra two ampules of epi.
    Dr Stewart Gibson, Port Elizabeth, South Africa

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  6. Last June I got an epipen jr for my peanut allergic daughter. This year when we went to the allergist, I realized that the epipen had expired in January! When we got the thing it only had a 6 mos shelf life. Now my insurance has changed and I have a super high deductible. It is going to cost me $150 for it now....I wish there was a reliable alternative. I am just going to have to fork the cash over, but I will check to make sure the expiriation date is more than 6 mos out.

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  7. Be sure to ask the pharmacy to dispense an EpiPen that is good for at least 12 months. Many times, the pharmacy tries to get rid of its older stock first, so they don't have to discard it, but you don't have to accept it! Also, you may want to consider getting the generic version of Adrenaclick (which will, however, require retraining). See my more recent post about this issue (May 2010).

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    Replies
    1. I have a severe bee sting allergy and was trained by my dr. to inject myself about 40 yrs ago with a bee sting "kit" (pre-filled syringe and a swab) cost then, only a few dollars. Are they still available? and where? I am retired and can't afford to spend $ 300.00 on an epipen and discard it after a few month.

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  8. @Casey - I just got an epipen rx filled for my son. I didn't notice the expiration date (of 01-11) until I left the store. I went back and learned that the pharmacy could have legally sold me an epipen that expired the next month (less than 2 weeks away)! Lesson learned, check the date before I pay.

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  9. I just filled an RX this week for a Twinject. One Walmart tried to convince me the Epi Jr and Twinject were the same. I left there and took my RX with me. Another Walmart had to order it because they don't carry it in stock. Guess What? I opened it this morning and it expires in 6 months. Grrrr! I am calling the pharmacy, when they open. Twinjects are expensive enough without buying them twice per year.

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  10. As someone that nearly died the day after Christmas from a nut allergy...ask for the brandname EPIPEN~ not generic...I got a generic Chinese model from RiteAid and it did not work properly. Have since found that that brand (although not that specific model) was recalled.

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  11. I just shelled out over $86 for an Epipen in Washington DC that will expire in 9 months or so. It was the only one available at the pharmacy. I am perfectly capable of filling a syringe and I think it's obscene to charge so much for something like this.

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  12. I actually called Roche today and I learned that the multidose vial of epinephrine is only stable for 24 hours after the seal has been broken. I didn't ask the question but I assume that having pre-filled syringes are not a good idea! :( This sucks because epi-pens are way too expensive!!!

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    Replies
    1. You may find the following exchange from the AAAAI's "Ask the Expert" series helpful.
      http://www.aaaai.org/ask-the-expert/effect-of-light-on-epinephrine.aspx
      For ease of administration, I keep EpiPens stocked in my office.

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    2. I just paid $207 for the double pack epipen at a Sam's Club in Virginia. It was $157 in N.C. last year in June. I called the same pharmacy and was told it had gone up $100 since last year which left me paying the $207 at Sam's. I have mammalian meat allergy because of Lone Star ticks and never know, due to the delay in the allergy between 3-6 hours, when I have cross contaminated prepared foods not listed as having meat products added.

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  13. I just purchased 2 double pack epi-pens for my daughter at a cost of 456.04! It went up just over 100.00 in the past 12 months. I made sure that I received ones that lasted at least a year. It is unfortunate that these cost so much money. I asked if there was a generic and the Pharmacist told me no.

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  14. a question to MDs out there: does epinephrine come in the form of a carpule, like those that are used for anethesia in dental offices?
    I got stung by stickershock yesterday when i bought my first double pack epi-pen. I need to carry them now when i bicycle in remote areas in case a bee/wasp chooses to sting me on the neck. the epipen is so large and heavy to carry, a syringe with the vial would be much lighter, and hopefully not cost $198 (i didnt know i got a bargain! expiration date: october 2013. lucky me.)

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    Replies
    1. Epinephrine is available in glass ampules. However, the medication is both light and temperature sensitive and can degrade when exposed to air. Therefore, a prefilled syringe is probably not a great idea unless you replace it frequently. If the size of the EpiPen is cumbersome, you may wish to consider the Auvi-Q, a more compact epinephrine autoinjector.

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  15. My daughter is 7 years old and has a peanut allergy that we found out about when she was 10 months old. She's not had an allergic reaction...until today. She apparently ingested 2 peanut M&Ms from another child in her class during lunch. She didn't have a severe reaction like she did when she was 10 months old. At that time she broke out in hives, swelled so much she was unrecognizable and stopped breathing on me for a few seconds before I could get her to the hospital. So you can imagine how frantic I was when I got a phone call today that she had ingested peanuts. She complained that her throat was itchy and she itched everywhere a little. By the time I got to her school (about 10 min. after the call; 20 min. after her ingesting it and telling the teacher) she did not have hives, nothing was swollen that I could see or feel but her throat looked a little more swollen than normal. We gave her some benedryl and have been watching her since. We had an Epi but it was expired. I called her Peditrician's office to get the new script called in. When my husband went to go pick it up we found out that it was over $200.00. Usually it falls under the 3rd tier of our insurance plan and we pay a high co-pay of like $60.00-75.00. So he was asking the tech why it was so expensive. This is a new insurance company for us and we've never filled a script using them before. The Pharmacist actually had the nerve to joke and laugh at my husband. He didn't even talk to my husband but was making jokes to the other techs about "How much did he expect it to be, haha hahaha". Maybe I'm still emotionally raw from having the crap scared out of me but I don't see anything funny about a medication that could potentially save my daughter's life being so expensive that we can't afford it! I called the Peditrician's office back to see if there is a generic or Tier 1 for Coventry One Insurance that they could prescribe instead and was told no there isn't anything else in the event she goes into analphletic (sp) shock. So if anyone knows of an alternative that is safe and will work the same, please let me know. She's gone so long without an incident I guess we have gotten slack in reminding her she can't eat candies, baked goods, etc. without asking if it contains peanuts first. Any help would be appreciated.

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    1. It seems awful to say it, but $200 will seem like a bargain if your daughter is unlucky enough to ever experience another systemic allergic reaction. However, I understand that budgets are tight, and it can be difficult to fork over so much money for a medication you hope to never use. I think of it as insurance - most people would think $200/year for a life insurance or disability insurance policy would be a great deal. That said, there are currently coupons available to assist you with your out-of-pocket expenses, taking up to $100 of the cost of each 2-pack. Talk to your doctor to see if they have any coupons in stock, or visit the EpiPen or Auvi-Q websites.

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  16. I SPECIFICALLY requested that my doctor prescribe only ONE EpiPen since I (gratefully) have thrown them after not being stung (anaphylaxis if stung by bee). I about fell on the floor when, even with insurance, the cost was over $98 at WalMart. They filled the Rx with a twin pack and, when I questioned why they didn't follow MD order, they insisted that it is ONLY available as a twin pack. What a scam! There is no way on a tight budget as a single person that I can afford it. I told them to restock it and I pray I'm within 15 minutes of a hospital if I get stung.

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    Replies
    1. The reason that Epinephrine autoinjectors are now only sold in 2-packs is because ~20% of the time that epinephrine is required in an allergic emergency, a second dose is needed in order to quell the reaction. Now that competitors are on the market, I expect to see some price wars in order to gain/maintain market share. There are currently excellent coupons available for both the EpiPen and Auvi-Q which may substantially reduce your out-of-pocket expense.

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  17. Thank you for the information that there are discounts available on their websites! I've always been allergic to ants but the reactions are getting worse. After having trouble breathing and throat swelling with the attack Wednesday, I've decided it's time to pony up and pay for a trip to the doctor and an epi-pen. It's out of my price range, so it really helps to know that I can get them cheaper!

    Thank you so much!

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