How to use an epinephrine autoinjector
For some California families, the start of a new school year means it’s time to restock on EpiPens, the pocket-sized devices used to deliver a lifesaving antidote called epinephrine to people with severe allergies to food, insect stings or medications.
When parents make the purchases this time, however, they may experience a severe reaction to the price tag, which has increased more than 600 percent during the last decade.
That price hike has come to light this week as members of Congress urge an investigation into EpiPen manufacturer Mylan Specialty, a New Jersey-based pharmaceutical company. Mylan has inched up the cost of the prescription medication to $600 for a two-pen pack. That’s bad news for children and adults who rely on the pens, said Dr. Priya Balasubramanian, a gastroenterologist at Kaiser Permanente Roseville Medical Center and mother of a teenager with severe food allergies.
Most people who’ve experienced a severe allergic reaction keep EpiPens at home, work and school. EpiPen is the only well-known epinephrine injector out there, so the manufacturer has been able to increase prices without much consequence, Balasubramanian said. Only some insurance plans cover the device, so many consumers end up paying out of pocket. The manufacturer does offer $100 coupon cards to cover co-pays for people who meet the financial criteria.
A California law that took effect last year requires every school to stock two sets of EpiPens, which they can get for free by applying through Mylan’s EpiPen4Schools project. But allergists and school nurses are concerned that children who normally come with their own personal pens will be unprepared this year because of the high cost, increasing the demand on the school supply.
The Bee had a chat with Dr. Balasubramanian, who leads a Sacramento food allergy support group, about how the inflated pricing will affect local families.
Q: What was your reaction when you read about the EpiPen price jump?
A: Obviously, it’s very sad. This isn’t a medication people can choose not to have. It’s a significant burden on families, because usually you don’t just have to have one. You have to have multiple to cover day care, schools, after school programs and one for home.
Q: What is an EpiPen?
A: The EpiPen is a system of administering epinephrine, and it’s used in the event of an anaphylactic reaction. If you give it early, it can be lifesaving. In its absence, what will happen is the individual undergoing anaphylaxis will die. In every sense of the word, it’s lifesaving.
Q: What does it do?
A: When there is an exposure to a food that sets up an allergic reaction, there’s a series of events that happen in the body that involve histamine release. It’s like a cascade. One step leads to the next, and at the end of it you have anaphylaxis, which means people can stop breathing, their blood pressure can bottom out. Epinephrine arrests that cascade. It brings up your blood pressure and stops the reaction from progressing.
Q: Is the EpiPen the only device available for administering epinephrine?
A: There’s no competition, and I expect that’s what’s leading to the price increase. Avi-Q was pulled from the market. There is a generic version of epinephrine that is available and it is being prescribed. It can be pricey, but it’s better than the EpiPen, so that’s an alternative.
Q: Are EpiPens required in California schools?
A: A law took effect last year that requires schools to have stock EpiPens (not prescribed to a particular individual).
There was another bill this year that was the epinephrine stocking initiative, which allowed doctors to prescribe it to schools. Right now the doctors have to prescribe it for a specific patient and there’s no malpractice protection (for stock EpiPens). The physicians are still open to liability and litigation. This bill might close that loophole.
Q: Why do you think these kinds of price hikes happen?
A: It’s terrible. Maximizing value to your stockholders is one thing, but you can’t do it on the backs of people who, really, this is a life-or-death situation for them. Mylan isn’t the only company who does this. Lots of companies do it with the hepatitis C medications.
Q: What are the options for people with food allergies who cannot afford the out-of-pocket costs of the EpiPen?
A: You have to find good insurance, and there are assistance programs for people who can’t afford the medication. There is a Mylan EpiPen patient-assistance program, and you’d have to meet certain financial requirements to be eligible.
Q: Your teenage son is allergic to eggs and peanuts. How has that impacted your family?
A: It’s life-changing in the way that it becomes the most important part of your life. Food is no longer something you can serve without thinking about it. He was a toddler and we’d send him to day care and anytime the phone rang, I would worry. It never leaves your life.
Editor’s note: This story was changed Aug. 25, 2016, to reflect that the epinephrine stocking initiative allows doctors to prescribe the drug to schools but doesn’t assign money for schools to purchase it. The story was also changed to reflect that Dr. Priya Balasubramanian’s son is not allergic to milk.