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#EpiGate :: Enough with the Generics Already

Mylan recently announced that they will soon offer a generic version of the EpiPen, which will be available at about half the price. This news is confusing to those who have been following the headlines of #EpiGate. The news keeps insisting that there are already generic alternatives out there. So, why does it matter so much that Mylan is making a generic EpiPen when there were generics already available?

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Well, it matters because the so-called generics the media keeps telling you about? They’re just not the same thing.

You’ve probably seen articles about the cheapest alternative to the EpiPen—a simple syringe and vial. (This one suggests making a carrying case out of a breath mint tin. Doesn’t get much cheaper than that!) It is the same medicine that you find in the pen, but here’s the thing—in this case, it isn’t about the medicine itself. The big difference is how the medicine is delivered. There’s just no comparison between an auto-injector and having to inject manually.

During an anaphylactic reaction, there’s not much time to act. You have limited time to realize that something is wrong, determine that it’s an allergic reaction, grab your breath mint tin, pull out the syringe, fill it with the correct dosage—and then inject it. That’s a lot of steps to get through in a life and death situation—a lot of steps for a parent watching their child gasping for air. Too many steps for a bystander who is trying to help but has not had any medical training. A lot of steps for someone struggling to breathe, her eyes swelling shut, trying to inject the medicine herself.

With the EpiPen, you pull off the top, press the orange end against the outer thigh, and push until you hear a click. Count to three, and you’re done! When you pull the pen back, the orange end pops out to cover up the needle to prevent accidental sticks. And that’s it. So easy a child could do it—which is the point. Plus, it’s already loaded with the correct dosage. I cannot even imagine trying to remember how much I’m supposed to use for my son’s current weight while I’m freaking out in the middle of a severe reaction. I can’t imagine a five-year-old being able to do that ever.

My final point on the syringe-and-vial system is this: the medicine loses potency more quickly than it does in the pen, so you have to replace it every few months. A small amount of inconvenience, yes, but when taken along with all of the other factors? To me, there’s just no way that it adds up to a reasonable replacement for the EpiPen.

But what about the other alternative that’s been in the news, you ask? The Adrenaclick. It’s pre-loaded with the correct dosage, and it automatically dispenses the medicine—just like EpiPen.

Good question. The Adrenaclick is a direct competitor to the EpiPen and may or may not actually cost less. Prior to Mylan’s announcement of its generic, Adrenaclick’s generic was the one often referred to in the news. Both the Adrenaclick and its generic are made by the same company, and again, it’s a matter of how the medication is delivered.

While Adrenaclick has the same medicine as an EpiPen (epinephrine), the device doesn’t operate the same way. It requires an extra step to expose the needle, you have to hold it for a 10 count, and the needle remains exposed after injection. Maybe all of that is not a big deal if that’s the method you’re used to using, but given the sheer domination of the EpiPen in the market, many teachers, daycare workers—and even parents—are trained in how to use that specific device. I have enough anxiety about sending my kindergartener off to school where I can’t personally check every food that he eats for allergens. It’s important to me to have the device his caregivers are familiar with and will be confident using in an emergency.

Also? Good luck trying to find Adrenaclick. What the big headlines forget to mention is that not all pharmacies carry Adrenaclick or its generic. They may be able to order them—if your doctor’s prescription allows for it.

I liked the Auvi-Q, which is another auto-injector that was recalled and taken off the market. It had all of the features of the EpiPen, plus it was small enough to fit into a pocket. Additionally, it had audio instructions so anyone could pick it up and use it in an emergency. I was sad to see it go.

Mylan’s generic EpiPen is supposed to be available later this year. There are also other companies working on new EpiPen alternatives. Hopefully a reliable, low-cost generic epinephrine auto-injector soon becomes widely available to those who need it.

Many thanks to the members of the Food Allergy Community of Tennessee who shared their thoughts with me for this post.

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