Cheaper "do-it-yourself" alternative to EpiPen may be risky
Many allergy sufferers have been in a panic over the skyrocketing cost of EpiPens, used to reverse potentially life-threatening reactions to peanuts, bee stings, and other allergens. A much cheaper do-it-yourself alternative exists, but some emergency doctors say that the affordable option carries a number of serious risks.
The company that makes EpiPen, Mylan, charges $608 for a two-pack of their brand-name device. And even though the company announced Monday that it will be offering a less pricey generic version in the weeks ahead, it will still carry a $300 per two-pack price tag, leaving it well beyond the budgets of many families.
So some people are turning to a more budget-friendly method of treatment that some paramedics have relied upon for a while: a traditional syringe and a vial of epinephrine.
The cost is about $20 – $15 for a syringe and $5 for a vial or two of the drug. Both can be purchased through local pharmacies if you have a doctor’s prescription.
Dr. Howard Mell, an emergency physician in Winston Salem, North Carolina, and medical director for Iredell County EMS, told CBS News there are drawbacks to the less expensive do-it-yourself syringe option, though.
Mell, a spokesperson for the American College of Emergency Physicians, trains emergency workers and camp counselors on how to use EpiPens in allergic emergencies. He also has a daughter with a severe peanut allergy, so the topic is near and dear to his heart.
“We had the very scary experience of losing her pulse. We were in Disney World and I had to do CPR. It was two and a half years ago – she was 7. If it gets to the point where someone loses their pulse, one EpiPen may not be enough. People do need more than one on occasion; it’s not particularly infrequent. If you look at a family that has to take care of this, the cost is astronomical,” he said.
When it comes to the more affordable refillable syringe method, getting the dose potentially wrong is a real concern, he said. Using this method involves two steps: drawing up the correct amount of epinephrine from a vial using a syringe and then switching needles and administering the medication into the allergy victim intramuscularly.
If any of the medicine is accidentally spilled, the correct dose could be missed. Also, he said, “You need to make sure to get the right depth of the needle in because you don’t want to administer it too shallowly.”
The EpiPen, on the other hand, is preset to do that for you.
Having a family doctor pre-fill the syringe is an option that some families are choosing. But Mell said he’s wary of this method, too, and not certain how long the drug remains effective once it’s in the syringe. The medication is temperature sensitive, which raises the question of where and how long the syringes can be stored. Tucking it into a purse or an emergency kit in a car, where temperatures can shift depending on the location and season, aren’t necessarily safe options.
“Even if all of those issues are addressed, it would take a fair amount of experience to assure the drug was delivered correctly,” Mell said. “If all of that could be overcome, sure – but that is tough even for professionals not personally involved with the patient. For self-treatment or family treatment, it is really sub-optimal.”
That moment when a patient is suffering from anaphylactic shock requires quick action and clear thought. Even though Mell and his wife have trained their daughter carefully and often on how to use her EpiPen by herself in an emergency, the timeframe to act is tight and it can be extremely challenging to self-treat because a person’s blood pressure may be dropping quickly, anxiety is high and their thinking may be unclear.
“She may only have 30 seconds to react before she won’t be able to react,” Mell said. “The idea that she could draw it up from a vial and administer it to herself, it is ridiculous.” He said even his wife, a health educator, says she’d be hesitant to use the syringe method due to the increased risk.
“If it’s a choice between they get an EpiPen and the family doesn’t have electricity this month, then it’s an option,” he said. But he stressing the need for thorough training before a family tries this option. Even a school nurse in a child’s school would need rigorous training, he added.
A number of states now let emergency workers use the lower-cost syringe method of administering epinephrine, including Mell’s state of North Carolina, but he said that most EMTs he works with still give epinephrine through an auto-injector because the margin for error is smaller.
New York State also allows emergency workers to use the syringe and vial method, but Dr. Robert Glatter, an emergency physician for Lenox Hill Hospital in New York City, said he hasn’t seen it used.
“I think it’s out there, but you’re talking about your life,” Glatter told CBS News.
A generic EpiPen version, once available, may help some families reduce cost.
Another epinephrine auto injector called Adrenaclick, by Amedra Pharmaceuticals, is also available. It costs less than EpiPen, but it may be harder to get a hold of, Mell said.
“It’s manufactured in very limited supply. I have two of them in my first aid kit,” said Mell.
Users should be aware that Adrenaclick’s steps are different from an EpiPen, “so you have to know how to use it. But it’s still an auto injector.”
There are two other slightly less expensive brands of auto injectors available in Canada but not in the U.S. because they did not pass FDA approval guidelines.
“Money is a concern but we want safety and efficacy first,” said Glatter, also a spokesperson for the American College of Emergency Physicians.
He stressed that patients shouldn’t have to bear greater health risks due to inflated drug prices.
“I think this is an egregious example of a pharmaceutical company charging a price for a drug that is unwarranted and the pharmaceutical company needs to take a clear look at how they can better effectively bring prices down in order to serve the people they are entrusted to make the product for,” Glatter said.