High prices on Mylan's EpiPen drive EMTs, patients to manual options

Mylan’s EpiPen faces scant competition in the epinephrine auto-injector market. But something else is turning some patients away from the med: the company’s prices.

Emergency medical responders and families alike are using manual syringes to avoid the high costs of EpiPen, whose price has increased more than 5-fold since 2004, STAT reports.

While the syringes aren’t perfect--using the approach to get the correct dose administered safely requires medical training--in some cases, agencies have found that the the savings from making the switch is enough to cover that training. An official from the Broadlands-Longview Fire Protection District in Central Illinois, for one, told STAT that eschewing EpiPen for regular syringes would save at least $2,200--enough to train 5 firefighters as emergency medical technicians.

Meanwhile, first responders in Seattle have developed a kit to use in place of EpiPen when treating severe allergies. King County EMS--which sells the kits without epinephrine for $15 apiece to health agencies in states including Alaska, Utah and Oregon--saved more than $150,000 in one year; across the country, it’s estimated that a pilot program using similar kits could save more than $1 million if implemented statewide.

Mylan, a generics giant, has managed to reap blockbuster revenues from its star product thanks to a 450%-plus price increase since 2004, adjusting for inflation, STAT notes, citing data from Elsevier’s Gold Standard Drug Database. And Mylan, for its part, told the publication that the increases “reflect the multiple, important product features and the value the product provides.”

But a lack of competition has also allowed prices to keep soaring. In 2013, Mylan got its first serious challenger in 25 years in the form of Auvi-Q from Sanofi. But last year, an injector fault triggered a hefty recall of the product, spurring the French pharma giant to pull the product from the market and later bail on its marketing partnership with PDL BioPharma.

Rivals’ development efforts have been thwarted, too: Just ask Teva, which received an FDA rejection for its generic version. With “certain major deficiencies” to correct, the Israeli pharma said earlier this year that it expects significant delays for the product, which now won’t roll out before 2017.

And even more recently, U.S. regulators threw up a wall in front of Adamis, asking for more data on its prefilled epinephrine syringe. And while the product wouldn’t have been a large competitor for mammoth EpiPen, it could have “added to managed care pressures” through its stated strategy of acting as a discounted product, Evercore ISI analyst wrote at the time.

But while Mylan may have free rein, it may want to pay heed if market share continue to slip to manual syringes--and some doctors predict it will. As South Florida-based allergy doctor Richard Lockey told STAT, high costs will likely spur more patients to look for other options--with 1 of 6 of his patients already electing to go with the cheaper alternative.

Is the syringe solution ideal? “Well, no, not necessarily,” he told STAT. “It’s better to have an auto-injector, yes.” But “everyone wants to drive around in a Cadillac,” he said, and “not everybody does.”

- get more from STAT

Special Reports: Top 20 generics companies by 2014 revenue - Mylan | 10 brands keep pumping out big bucks, with a little help from price hikes

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