Texas Allergy, Asthma and Immunology Society Statement on Epinephrine Auto-Injector Accessibility, 8/30/2016

Millions of Texans have insect, food and drug allergies and are at risk of life threatening anaphylaxis.  Injectable epinephrine is the only life saving treatment for anaphylaxis and must be available at all times for patients with these disorders. The mission of the Texas Allergy, Asthma and Immunology Society (TAAIS) is to improve the quality of life of Texans who suffer from allergies, asthma and immunodeficiencies. Therefore, TAAIS is concerned that the recent increased cost to consumers for EpiPen and EpiPen, Jr has already and will continue to limit access to this life saving medication for patients.  The cost has increased over 400% since Mylan, the supplier of EpiPen, acquired the medication in 2007.

Reasons for the limited access to injectable epinephrine include the following: 1) significantly increased use of high-deductible insurance plans by families which transfer the burden of medical costs to the consumer, 2) the recall of Auvi-Q from the market in 2015 and the lack of many alternative choices for injectable epinephrine, and 3) increased demand for prescriptions for injectable epinephrine during the Fall, when children go back to school.

The School Access to Emergency Epinephrine Act, passed in 2013, allowed schools to have stock epinephrine and, in Texas, Senate Bill 66 was passed last year to allow Texas public and charter schools to stock epinephrine in schools. TAAIS is concerned that the current high cost of EpiPen and EpiPen, Jr will limit the access for schools if the EpiPen 4 Schools program (the manufacturer’s program to provide free injectors to schools) is reduced or discontinued. TAAIS is in strong support of continuance of this program for Texas schools. TAAIS applauds the recent increase in a co-pay assistance card from $100 to $300 by Mylan to help patients obtain EpiPen.

Given the barriers that Texas allergic patients have experienced in obtaining affordable injectable epinephrine, TAAIS has identified the following resources for allergists and patients:

1) First, determine if EpiPen is covered by your patient’s insurance plan. Premiums, prescription coverage, out-of-pocket limits and deductibles often vary tremendously. Many plans have separate pharmacy and medical expense deductibles.  If the EpiPen is not covered, and if the co-pay is less than $300, use the co-pay coupon on the manufacturer’s website.  (My EpiPen Savings Card® at https://www.epipen.com/copay-offer/) This is available for up to three EpiPen 2-Pak® or EpiPen Jr 2-Pak® cartons.

2) A lesser known product is currently available potentially as a lower cost alternative to EpiPen, and can be prescribed as “generic epinephrine auto-injector”. Consumer Reports (August 11, 2016) reported the cost at only $142 at Walmart and Sam’s Club using a coupon from the website http://www.goodrx.com/. The manufacturer of generic epinephrine also offers a $0 co-pay coupon card for commercially insured patients; and cash paying patients may receive up to $300 off their out-of-pocket cost.

3) Patient Assistance Programs are available on the website www.RxAssist.org. (Search “epinephrine”) Uninsured patients who make no more than 200% of the Federal Poverty Level can use Mylan’s Patient Assistance Program through this website to receive free EpiPen auto injectors.

4) If possible, patients may need to explore other health insurance plan options.

5) Check pricing with different pharmacies in your area.

6) When an insurer does not provide affordable access to epinephrine — either by refusing to cover the medication or only covering a small amount of the cost — you can initiate an appeals process through the insurance carrier.

7) Make sure you know how to use all available devices.  Use a trainer to ensure patients understand how to use their specific medication.  Education can be obtained through doctor's offices, at the pharmacy or through online videos: (https://www.epipen.com/about-epipen/how-to-use-epipen, http://www.epinephrineautoinject.com/how_to_use_epinephrine_injection_USP_auto_injector.php).

The Texas Allergy, Asthma and Immunology Society (TAAIS) is committed to improving the quality of life for patients with allergies and has worked hard to encourage legislation like Senate Bill 66 that supports our members and patients. We hope the resources above help decrease the difficulties experienced due to the current high cost of epinephrine for patients and schools in Texas. If you have any concerns or need further help, please contact TAAIS Executive Director Connie Mawer at cmawer@taais.org.