Some relief is available from the high price of the EpiPen, but not for the general public.
Medical care providers statewide, including Mohawk Ambulance Service in the Capital Region, are participating in a pilot program led by an Albany Medical Center doctor that allows a wider range of medical professionals to measure and inject epinephrine with syringes at a cost of a few dollars per dose, rather than the hundreds of dollars that the EpiPen now costs.
Either one will potentially save the life of an allergy sufferer going into anaphylactic shock. But the EpiPen can be administered by anybody without training — jab it into the thigh and it automatically injects the correct dose of the drug.
EpiPens are the latest focus of national anger over the high cost of medication, as drug company Mylan has gradually raised the price to $600 for a two-pack. (A second shot may be needed during severe reactions, so for safety’s sake, the follow-up dose should be ready in case the patient goes back into anaphylactic shock after an apparent recovery.)
Compounding the problem, the drug epinephrine has a short shelf life and is degraded by light, heat and cold, so EpiPens need to be replaced as frequently as every 12 months, running the parents of a child with a peanut allergy hundreds of dollars a year, or the operator of a fleet of ambulances tens of thousands of dollars a year.
Mohawk Ambulance President James P. McPartlon III said the cost of an EpiPen has risen more than tenfold in the past 12 years. Each ambulance would cost $1,800 per year to equip with EpiPens, as it needed multiple units in both the adult and child dosage.
Dr. Michael Dailey, chief of the Division of Prehospital and Operational Medicine and an associate professor in the Department of Emergency Medicine at Albany Medical College, said the “Check & Inject NY” pilot program presents a low-cost alternative for treating anaphylactic shock. Over-the-counter antihistamines may work for a mild allergic reaction such as itching or sneezing, but an EpiPen or the equivalent is needed for anaphylaxis.
“You absolutely have to take epinephrine,” he said. “There is no answer other than epinephrine.”
Two alternatives to the EpiPen have been introduced, Dailey said — one was withdrawn from the market and the other is only slightly less expensive. Pre-measured syringes of epinephrine have been tested and are very inexpensive, but their shelf life is not even one-tenth of the EpiPen — they must be replaced monthly, eating a lot of the savings.
A previous pilot program greatly expanded the ranks of those authorized to administer heroin overdose medication, and has been highly successful, Dailey said, with many opioid drug abusers being brought back from the brink of death.
Check & Inject NY follows the same model — training and authorizing more people to draw epinephrine from a vial into a syringe and inject it. In New York, paramedics are authorized to fill syringes as part of advanced life support treatment. Emergency medical technicians, by contrast, perform basic life support treatment and cannot fill syringes.
But under the pilot program, EMTs can be trained and authorized to draw epinephrine from vials.
“The EMTs across the state, volunteer or paid, are really a group of health care professionals,” Dailey said. “Giving them additional skills and training is something they take to really well.”
He said syringes specifically marked with adult and child dosages of epinephrine are being issued for this program. Combined cost of syringe and drug vial is a small fraction of the cost of an EpiPen.
So far, Dailey added, it has been a success, with members of 460 agencies trained and more than two dozen real-life situations with good endings. “We’ve had 29 successful deployments across the state,” he said.
McPartlon said in a news release that Mohawk has purchased syringe epinephrine kits for its ambulances and all Mohawk EMTs have received the necessary training in their use. “The kit makes it very clear for staff to provide the correct dose of the medication to patients and the training has helped us to easily integrate these devices into our scope of practice.”
The directors of Check & Inject NY will issue a progress report to the state Department of Health on Sept. 13. They are hoping to make the pilot program permanent before it ends next year.
Meanwhile, for the general public, Mylan announced Monday that it will sell a generic version of the EpiPen for half the cost of the name-brand product — $300 for a two-pack.
Dailey said anyone who might need an EpiPen — school nurses, operators of children’s facilities, parents whose kids have had severe allergic reactions, anyone who previously has gone into anaphylactic shock — should still get an EpiPen or the equivalent, despite the cost.
The problem is that every patient’s reaction to a triggering substance is different — faster, slower, milder, more severe — and there may not be time to call an ambulance. On top of that, the triggering substances vary in potency. A trace of peanut oil left over in a frying pan may not be as bad as a chocolate-peanut candy bar. A bee sting in the mouth may be much worse than one on the foot.
Epinephrine should be administered “in all cases as soon as possible,” Dailey said.
Reach Gazette reporter John Cropley at 395-3104, [email protected] or @cropjohn on Twitter.