You have a running nose, you reach for the kleenex. The facial tissue market was dominated for so long by the brand Kleenex® facial tissue in market share and advertising that the term became synonymous for the brand.
The recent uproar over the cost of the EpiPen®, an emergency injection (“shot”) of epinephrine has captured media attention. It is a medicine used for life-threatening allergic reactions such as severe swelling, breathing problems, or loss of blood pressure.
Besides its use on ambulance services, many families have the prescription on hand for peanut, insect bites, or other common, often severe allergic reactions.
Doctors have, for years, simply prescribed EpiPen for their prescriptions, not realizing EpiPen is a brand name. Why? Because EpiPen has done such a great job at making their delivery system, a term for the drug epinephrine.
The EpiPen can be a self-injected way to quell the allergic effects that may be encountered. The patented delivery system allows the needle to retract after being administered.
One alternative to EpiPen, Adrenaclick® is also a self administered needle delivery system for the drug epinephrine. The needle on the Adrenaclick pen does not retract, rather requires the user to put a cap on the needle after use. Same drug, same dosage, different delivery system with two caps instead of the one cap on the EpiPen.
The big difference between the two epinephrine systems is also the price. The EpiPen can cost as much as four to five times the cost of the Adrenaclick.
Unfortunately for users, most doctors are unaware of EpiPen alternatives and use the name when prescribing epinephrine.
According to Paul Fera, the Lyons Ambulance Administrator, after the Times informed him of the EpiPen competitor, he investigated the Adrenaclick alternative and found it for $142 on the Walmart website. Far less than the $600+ for the EpiPen
The same can be said for inhalers used by asthma sufferers. Ventrolin HFA is the big boy on the block delivering the drug albuteral into the system. Along with Pro-Air® and Proventil®, the three manufacturers dominate what used to be an inexpensive inhaler market. There are several different brands, each with their own delivery system containing the same drug.
It all changed, according to Palmyra Pharmacy owner/pharmacist, Dave Stachnik, when the government wanted fluoro carbons taken out of inhalers. What became better for the air quality of the earth, cut the number of producers of inhalers down from perhaps 50 to the big three producers today. Inhalers that could be supplied for a $5 co-pay jumped to a $50 co-pay. “We (pharmacists) make only a $1.50 per inhaler,” said Dave. Doctors have become so familiarized with the dominate inhalers they often forget to check out the competition, or check ‘generic equivalent’ on prescriptions.
As for the EpiPen/competitor controversy, Stachnik said doctors have EpiPen stuck in their minds.
While the erectile dysfunction companies supplying Viagra, Cialis and Levrita have cornered the market in the U.S., there are simple, safe off-brands and generic solutions. A prescription to Viagra, or Cialis may cost, with approval of your health plan, $300-$400. The same drug purchased through a reliable mail supply Canadian Pharmacy is $65. There is a strictly generic version, that has the same effect for only $39.39 per month.
The problem with many popular prescription drugs is that customers in the U.S. market, dominated by advertising and brand names recognition, are supplementing other countries lower costs, according to Stachnik.
As far as the EpiPens for use on ambulance rigs, agencies are required to have autoinjectors (EpiPens) on board because of state regulations. The cost is roughly $600 for two of them. They come two in a pack.
The Times interviewed Wayne County EMS Coordinator, Bill Liddle concerning what area ambulace services are considering.
“About a year ago, some of us - spearheaded by Dr. Cushman of Monroe County - started a “Check and Eject” program. It’s a demonstration project with the state, where agencies can apply to take part in the program.
With the program, we teach them to draw up Epinephrine in a special syringe. The syringe only has two markings on it - one for the adult dosage and the other marking would be the dosage for a pediatric patient. As part of the demonstration program, we’re teaching them how to draw that up and inject it into the patient.
When we started this program, basic EMTs were not permitted to inject people. By regulation, they were only permitted to use the autoinjector. We’re teaching them to recognize the differences between allergic reactions and true anaphylaxis.
That brings the cost down significantly. Right now, it’s less than $100, I don’t know the exact dollar amount on it. We’re hoping that we will eventually get the cost down to hopefully around the $20 range. That’s down the road a little ways.
We recently voted to accept this program and recommend to the Commissioner of Health that it become part of the scope of practice for a basic EMT here in New York State.
Epi is a very important and lifesaving medicine. Thank goodness it’s not used a tremendous amount of time. The average appears to be, of every 6,500 calls in the state, Epi is administered probably once. Now, when I say 6,500 calls, those are not allergic reaction calls, those are every kind of call.
That’s basically where it stands right now. We’re waiting for the Commissioner of Health to sign off. We are continuing the demonstration project, which is unusual because usually a demonstration project has a certain length of time. But with this particular one, because of the importance of getting the cost down, we voted to continue the demonstration project.
The autoinjectors only have a 12 to 18-month life expectancy, so it’s a relatively short expiration date. Currently, I think agencies in the state are probably spending $2 million per year on autoinjectors - on things that we’re required to have on board but aren’t necessary.
The kits that we’re using are specially manufactured for us by an EMS provider. The syringes are relatively inexpensive and a vial of Epi is $10 to $20. Of all the agencies in the state right now, I’m assuming there are around 300 involved with the program.
Until the Commissioner signs into this program, agencies still have to have an autoinjector on board to meet the requirements.”
Paul Fera, the Lyons Ambulance Administrator, said he is not in favor of the syringe method for epinephrine delivery on ambulance rigs. He said it would take too much time to retrieve the necessary equipment, draw the right amount for the patient and inject it into the patient. He added that as a paramedic he rarely draws any medications into syringes any more since many medications come in ready-to -go doses. “It (syringe drawing) is too time consuming and there is too much room for error.”
