Epipen Competition is Growing

Last year, Mylan the company that produces the EpiPen, received a lot of backlash for its increasing prices that reportedly preventing access for a number of people who require the medicine. The EpiPen is an injectable device that delivers epinephrine to those experiencing a severe allergic reaction. In the case of anaphylaxis, when the airways are closing, epinephrine is often life saving. Consumers and healthcare providers were therefore outraged when the price of EpiPens skyrocketed to $608.61 for a pack of 2 pens in 2016.

After the significant amount of negative press that Mylan received, and some changes in relevant policy, the EpiPen is now facing competition. Specifically, the major health insurance company, Cigna, decided to stop carrying the EpiPen in its brand-name form, and the major pharmacy, CVS, drastically reduced the price of a competing drug, the generic Adrenaclick auto-injector, thereby increasing its demand and lowering that of the EpiPen. The new price for generic Adrenaclick is $109.99 for 2 pens. In addition, a $100 coupon for CVS customers enables people to pay just $10 for this auto-injector, even if they are not insured.

In 2015, Mylan became the clear leader in the EpiPen market after a competing product, called Auvi-Q, which was produced by the French company Sanofi, was recalled due to problems with the device’s ability to deliver the correct amount of epinephrine. The vast majority of epinephrine prescriptions (over 95%) since then have been for EpiPens, but the start of 2017 has seen a sharp rise in the number of prescriptions for EpiPen competitors. An analysis performed on over 60,000 prescriptions for epinephrine auto-injectors made by more than 1400 medical providers in the United States showed that prescriptions for competitors to the EpiPen has more than quadrupled since the end of 2016. The EpiPen had 94.7% of the market share for auto-injectors in December 2016. By February of this year, that share had been reduced to 71.1%.

Auvi-Q has in recent weeks been reintroduced to the market by a drug maker called Kaleo. Unlike its competitors, Auvi-Q includes audio instructions that detail how to administer the epinephrine. Auvi-Q is also different from competitors in that it is being sold with a byzantine pricing structure. The pack of two auto-injectors is free for families who earn less than $100,000 a year. For others paying cash for the two-pack, the cost is $360. Insured patients pay $0 out of pocket, while health insurers are being charged $4500.

The fate of the EpiPen and its competitors is not clear. However, the good news is that access to life saving epinephrine auto-injectors is no longer a significant struggle. Given the swift reaction to the high prices for EpiPen and the efficiency with which solutions were provided, there is hope that these important medicines will always be accessible to those who need them.

Dr. Summit Shah

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