Today, CVS announced that it is now offering a cheap, generic alternative to a notoriously expensive product for sufferers of severe allergies: the EpiPen.
If you or someone you love has a serious allergy, you probably know the EpiPen as a branded, patented device that injects a dose of epinephrine into the thigh, reversing the symptoms of anaphylaxis (wheezing, swelling, trouble breathing) by raising the blood pressure and decreasing swelling. The devices are literally lifesavers for lots of people.
So, CVS is, understandably, getting a lot of attention for suddenly offering a highly discounted alternative to a really expensive product that a lot of people actually need. But cheaper alternatives have been on the market for years. So why doesn’t almost anyone use them?
The EpiPen is the best-known — though not the only — quick, emergency way to administer epinephrine to those having severe allergic reactions. The devices are single-use, and they expire after one year. For years, they cost about $94 for a pack of two. But the EpiPen maker, Mylan, began to raise prices about a decade ago, and in the last two years the price went up to more than $600 for that same pack of two. People were outraged. Even Hillary Clinton felt compelled to release a statement demanding that Mylan reduce its prices. It did not. Why would it have? The company had a 96 percent market share on auto-injector epinephrine devices.
In December 2016, Mylan released a generic version of the EpiPen known simply as “epinephrine injection USP,” which differed only in its label. The generic one costs $300 per two-pack without a prescription. By then, Mylan’s market share had dropped from 96 percent in August to 92.1 percent in October. Though Mylan’s share was still huge, people were clearly considering alternatives as Mylan gouged consumers and made headlines all over the country, none of them good. A representative from Athenahealth, authors of the original report, confirmed that through the month of December, 2016, Mylan’s market share remained at around 92 percent.
And though a much cheaper price tag and growing dissatisfaction with Mylan’s business practices are clearly eating into its market share, there are reasons people stick with EpiPen despite its price, even if they’re aware of other products. Mylan keeps much of the market it has captured simply because it already has it, and its name — EpiPen — is, like Tampax or Band Aid — synonymous with a general range of products that all perform similarly. Even doctors are not always aware that alternatives exist.
Dr. Susan Raschal, DO, of Covenant Allergy & Asthma Care in Chattanooga, Tennessee, attributes the success of EpiPen to its good marketing: “They have done a great job at marketing their product, and the name is the one that consumers and doctors know best, and they simply are not always aware of the alternatives.”
“They are simply not always aware of the alternatives.”
And, Dr. Raschal says that the severity of the allergy and the stakes involved keep people loyal. “In a situation where you’re a parent or a school teacher who has a child in anaphylaxis, you do not want to be reading instructions,” she says, “so people just go with what they know.” Adrenaclick, which also uses an auto-injector, is extremely similar in operation to EpiPen, but, Dr. Raschal says, “those little differences can make a difference, so people need to be educated. They need to know visually if what they’re holding in their hand is an EpiPen or something else, and they need to know how to use it.”
It makes sense, then, that someone who has had allergies all their life would develop a brand preference for whatever it is that they carry on them. Why change and take a chance? Dr. Raschal describes the epinephrine as “insurance” that the person carries with them. But parents of babies or toddlers who suddenly find out their children have severe allergies will be more agnostic, and in this case, which product they choose — EpiPen or Adrenaclick — should come down to price. “In terms of quality they all work very well,” Dr. Raschal says, and none are very hard to use.
Of the alternatives to the EpiPen, one of them, Adrenaclick, offers a very similar, pen-style auto-injector that retails for much less: The product is about $200 for a two-pack. It is this product that CVS has partnered with Impax to produce a generic version of. The pharmacy is selling them for $109 cash.
Though it’s unclear exactly why CVS chose to offer this product now, it’s clearly very good PR for it to do so, and a company spokesperson said that concerns over differences in how the pens work can be overcome with training devices that can be ordered. Erin Pensa, public relations director for CVS, says the products are “very similar and have few differences in design and usage, e.g., the need to remove two caps vs. one before using.” The timing is good for consumers: Cigna insurance company recently announced that it will no longer cover brand-name EpiPens.
Meanwhile, a whole new system for delivering emergency epinephrine is coming to market later this year. After some problems in dosage and a recall last year, pharmaceutical company Kaleo is set to release a product called AUVI-Q, which is shaped like a thin cigarette package equipped with a speaker that talks the user through the injection process.
Some pharmaceutical analysts have projected that Mylan, the bulk of whose profits are in the sale of EpiPens, is likely to lose big. Though some may balk at the concept of an entirely new delivery system of the drug, EpiPens have been almost exactly the same since the 1980s, and their manufacturer is asking far too much for them from a captive, and sometimes scared, consumer. Change is imminent, and good.