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Generic alternative requires proper training

WHEELING — As controversy swirls over price hikes for Mylan’s EpiPens, generic epinephrine auto-injectors offer a less-costly alternative but require training to administer the drug properly.

Each device provides an emergency injection of epinephrine, a medicine used for life-threatening allergic reactions. Mylan has responded to the criticism by announcing plans to release a generic version of the device in the coming weeks.

Dr. Clark Milton, director of medical education of the osteopathic family medicine program at Wheeling Hospital, said EpiPens are among the most popular delivery systems for epinephrine, which has been used to treat allergic reactions since the early 1900s.

Milton said the drug is already available generically in a version called Adrenaclick and as an epinephrine auto-injector.

“They are a little bit more complicated and have a different delivery system,” he said. “It takes some training. That is key: What is useful, what is trainable. For an auto injection, that is the key here.”

Regarding the drug’s effectiveness, Milton said, “The generic version has the same medicine as the proprietary version. One has to become educated with the delivery system with the generic, but it should be of equal usefulness.”

Milton warned, however, that laymen should not carry a vial of epinephrine and attempt to inject the drug with a syringe.

He said, “Medical services and EMTs and emergency departments are very well-trained in administering the correct dose (of epinephrine) at the correct dilution. That is what is difficult. … The vials are complicated and can be dangerous. The vials should just be limited for health care providers.”

Jami Robinson of Moundsville said she and her husband spend $2,000 every year to get EpiPens for their 12-year-old daughter, Audrey, who is allergic to peanuts and tree nuts.

“I carry two (EpiPens), she (Audrey) carries two and the nurse at school has some,” she said.

“We’ve carried EpiPens for more than 10 years now,” Robinson said. “We are used to that injector. … We’ve put our trust in them for years and obviously they (Mylan) have abused that trust. They have taken that and raised that price, knowing we are going to pay whatever we have to pay.”

Robinson, founder of Ohio Valley Kids With Food Allergies, a support group of about 150 families, said members make sacrifices to keep their children safe. As the price of EpiPens soars, she said, “They’re not paying for other things they need.”

Some families keep EpiPens past their expiration date because they cannot afford new injectors. Robinson said one family in the group has to buy EpiPens for three of their five children. She added, “Adults with food allergies are not buying them right now and hoping to avoid their allergen.”

Robinson has talked about the generic auto-injectors, but she said, “My daughter is so comfortable with EpiPen. … EpiPen is the most recognized epinephrine injector. … Right now, it’s a comfort issue. At the age when they start injecting themselves, you want them to be comfortable.”

She also is concerned that another person might not know how to use a less-familiar generic auto-injector if her daughter went into anaphylactic shock and could not administer the drug herself.

Amy Hicks of Glen Dale said she and her husband also have noticed the increasing cost of EpiPens that they purchase for their 11-year-old son.

“We found out that Aaron had a peanut allergy when he was 15 months old,” she said.

Regarding the escalating cost, Hicks said, “When we first had to start getting an EpiPen, they were free. Then after maybe a year and a half to two years, we had to pay $50 for a twin pack. When we filled his prescription for the set that is kept at school, it was almost $300 and that is with the coupon that Mylan keeps talking about.

“We have always used EpiPens,” she said. “Just last year, he (Aaron) started carrying a set with him and that set is now expired, so after just getting a two-pack for school, we now have to go and buy another set.”

Asked about generic epinephrine auto-injectors, Hicks said, “I honestly never knew that we had another option besides EpiPen.”

Karen Gerrero-Haught of St. Clairsville carries an EpiPen because of her severe allergy to aspartame.

“I have not tried the generic and didn’t even know it existed,” she said. “I guess I would fear whether the generic works as well or not. I probably would still opt for the name brand.”

The Good Rx website offers price comparisons for EpiPens and generic auto-injectors at chain pharmacies in the Wheeling area. According to Good Rx, the price for a two-pack of EpiPen Jr. at six area pharmacies ranges from $616 to $653, while the price for a two-pack of Adrenaclick’s generic version ranges from $145 to $377 at those drugstores.

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