The skeptical cardiologist described his own exciting episode of EpiPen usage while discussing the outrageously increased costs of the medication in a post last year., writing:
Although the active ingredient, epinephrine, is generic and cheap, and the basic delivery system has been around for decades, Mylan, the company that purchased the rights to EpiPen in 2007 has increased its price from 57$ per injector to 600$ for 2 injectors.
Lack of generic competition to the EpiPen is the primary reason that the price could be raised so much and also explains in many circumstances why drug costs are high in the US.
Two developments since then hopefully have cut into Mylan’s unseemly profits from the product: cheaper alternatives and cases of EpiPen failure.
As Fortune noted
Public and Congressional outrage not only forced Mylan to pay a $465 million settlement and launch a cheaper, generic version of the injection device, but it also spurred rivals and regulators to speed competing epinephrine injectors to market to lower costs.
EpiPen Failures and Recall
In April, two cases of EpiPen failures were reported and Mylan initiated a world-wide recall of EpiPen’s manufactured during a certain time period.
This recall announcement spurred me to examine the EpiPens I had, including one I carry in my work satchel and one I have at home.
To see if you have an EpiPen that should be recalled check the black box on the side of the injector for t
he Lot # and then go to this link on the Mylan webpage to determine if your EpiPen has been recalled. Follow the directions for getting a voucher for a free new one.
If you’re like me, you haven’t actually checked the expiration date for years and will be shocked to find that it was 6 years ago!
Generic AdrenaClick: A Cheaper Epinephrine Auto-injector (EAI)
I called my pharmacist to find out my options for replacing the EpiPen and discovered that my insurance company (UMR) did not cover EpiPens at all. I had already researched alternatives and discovered that Lineage Therapeutics makes one called AdrenaClick and they also are now offering a generic version of AdrenaClick which, with a coupon that is offered at their website, ends up costing 10$.
Fortunately, for me the website informed me that this product is my “GO-TO-CHOICE”:
*Impax authorized generic of Adrenaclick® (epinephrine
injection, USP auto-injector), also called epinephrine auto-injector or EAI. Impax EAI contains the same active medicine as EpiPen®. Impax EAI has numbered and color-coded instructions, designed for single-dose use by patients and caregivers. Impax EAI is a low-cost choice that is FDA approved… it’s the GO-TO-CHOICE for affordable, emergency treatment of allergic reactions (Type I) including anaphylaxis.
Consumer Reports has recommended this product. You need to have your doctor write the prescription for “epinephrine auto-injector.” and not for Epipen to insure proper substitution.
The technique for auto-injection is only slightly different from that of an EpiPen and you can view it here.
Shift To The Epi Auto-injector and Stick It To Mylan
It looks like I’m not the only one making a shift to a generic EAI.
This chart shows the dramatic rise that occurred in alternative prescriptions up to February, 2017
Mylan stock meanwhile, which dropped precipitously after adverse 
publicity (and my post?) in the fall of 2016 had been making a recovery but with the failed injections and the recall it is in free-fall again.
So, let’s all stick it to Mylan and when you happen to check your EpiPen and find that it expired 6 years ago replace it with something cheaper.
lancinatingly yours,
-ACP
p.s. I may never get around to writing about a useless drug called Yosprala that is being heavily marketed to physicians. The drug consists of two drugs which are cheap and available over the counter: aspirin and omeprazole (a proton pump inhibitor that reduces stomach acid and therefore ulcers.)
Yosprala sells for 150$/month. You can get either a baby aspirin (81 mg) or a full aspirin (325 mg) for pennies a day and 40 mg omeprazole (prilosec) for 46 cents per day.
Why would you pay 30 times as much for the combination?
If your doctor prescribes this stuff ask him if he has had any lunches with the Aralez pharmaceutical rep.
2 thoughts on “EpiPen Comeuppance: Cheaper Alternatives and A World-Wide Recall”
Dear dr Pearson, a question of curiosity (as a non practitioner): is there a therapeutic difference between racemic and synthetic epinephrine for injection? As I remember from a previous job that for inhalation it made a big difference, where the racemic version showed more effectiveness.
Racemic epinephrine only seems to be mentioned in the context of inhalation therapy for children