Quote from: SilverLining on August 12, 2017, 09:31:53 AM
The reason I was asking, there is a post on Facebook that people are sharing regarding generic epipens. I did point out the info is American (being shared by Canadians). But I also thought the price was inaccurate. It says it costs under $10.

Generic EpiPen made by Mylan (AB rated to the EpiPen brand) is $300 list. Copay assistance is here, currently only $25 and only valid for patients with commercial insurance.

At one point Impax Pharmaceuticals was discounting their generic epinephrine auto-injector during the whole EpiPen debacle being big in the news to $109.99 list - $100.00 coupon (max value) = $9.99 cash price for people without commercial insurance (TIME article), but now the coupon (here) is only $50, so that's $60 cash price. You also have to get the prescription written for Adrenaclick instead of the EpiPen in most states, as Adrenaclick and EpiPen brand are not AB rated and pharmacists in most states cannot substitute one for the other.

At this point it seems like generic Epi is probably the cheapest for Medicaid/Medicare/Tricare (although somebody on those programs would have to tell me if I'm wrong and the price is more than $60) and Auvi-Q is probably the cheapest if you either have commercial insurance (Kaleo gets it to zero out of pocket regardless of whether or not your insurer covers it) or if you don't have commercial insurance and make less than $100,000 a year (patient assistance program gets it to $0).

Well this is interesting...

http://www.kmov.com/story/36490815/missouri-to-get-3-million-in-epipen-settlement

$284.45 per twin pack for generic pi-pen.

Ask me how I know.  With 3 FA kids.

It costs under $10 to manufacture. Or it could, I guess, cost under $10 for a copay with really good insurance.

The reason I was asking, there is a post on Facebook that people are sharing regarding generic epipens. I did point out the info is American (being shared by Canadians). But I also thought the price was inaccurate. It says it costs under $10.

That's for generic?

I believe w/o insurance its $300  but with my insurance I think I pay $30 for a twin pack. 

What is the cost of the Mylan generic?

Glad I could help & that the pharmacist was able to order the Mylan generic for you.  My DD was very upset to not have an Epi-Pen until I let her compare the Mylan generic to the name brand. It's ridiculous.

Thanks MaryM. I'm so glad you told me you got the Adrenaclick! You made me open the boxes and it looks like I did too. The pharmacist was so nice and offered to take them back. He put in an order for the generic Mylan, like you suggested.

I also called Cigna, and they said we can get brand name, it requires prior authorization from a doctor, but they can get it. I'm told the difference is $80 give or take. Assuming I can get the generic Mylan, that's what I will do.

This is so frustrating!

I have Cigna & it's no name brand anymore.  We asked for the Mylan generic.  Originally the pharmacy gave us the Adrenaclick (?) but it was too different.  The Mylan generic Is exactly the same but it does not say Epi-Pen.

So...I went to get my kids' epipens refilled for school. Wow have things changed!

1) I'm told there's still a shortage, and the pharmacist said all the ones they get in are dated within the year now. None that he's seen last longer than a year!!!? I picked up a generic epipen yesterday with an expiration date of APRIL. They only place orders for them when they get a prescription, and he said they don't always get them when they order them???

2) I was told that my insurance company no longer covers the name brand, so I received generic. We have Cigna. I will be calling my insurance company next.

WTH??? Why is it still hard to get epipens and why are the dates so short and since when did insurance companies stop covering name brand of this?

The problem is the US pricing system is so opaque that it's impossible to tell who actually pays what for a drug.

First off, you get a list price. Larger pharmacy benefit managers will negotiate a discount on most brands or exclude them from coverage. Then you have pharmacy benefit manager rebates. They don't tell you what these are. Depending on your plan the PBM can keep all, some, or none of the amount (in large group plans they'll give the entire amount to the company responsible for the plan). When you're trying to pay your deductible off you might pay the $250 in entirety for a thirty day supply of drug xyz even though your PBM/company only spent $125 due to the PBM rebate.

Then we have coupons and copay cards. Example: I fill 90 days of drug ABC. Price my insurer tells me is is $750 (again, not realistic), my copay for a preferred brand is just short of $75. CVS at retail automatically applies a coupon that brings it barely above $30 for my out-of-pocket. Then you have the same thing with Auvi-Q: $9,000 price for four injectors, $90 copay, PSKW rebates the $90 on behalf of Kaléo Pharma, I'm zero out of pocket.

And for totally different price scales, Lineage (Adrenaclick) and Kaléo (Auvi-Q) basically do the same thing: Adrenaclick will rebate via copay card to $10 ($110 retail minus $100 max benefit) for people who don't have insurance, Kaléo will provide Auvi-Q for $0 for people with commercial insurance who refuses to cover it or don't have commercial insurance but make less than $100K/yr via patient assistance program.

I think the biggest problem is that the Lineage Adrenaclick, Mylan EpiPen/generic EpiPen, and Auvi-Q are all not A/B rated with each other so Adrenaclick cannot be substituted for a prescription written as EpiPen, even without the "dispense as written" box being filled.. Some states permit A/B rating substitution at pharmacist discretion, but even in the states that do it 90%+ of pharmacies (under a chain) the pharmacist won't exercise that right. Even before the whole EpiPen pricing outrage my local one store pharmacy substituted Adrenaclick for an Epipen prescription at their discretion (I think it was availability to fill, not copay, but I'm not sure).

Allergies have increasingly grown in public consciousness which is why people will fill EpiPens: Nobody wants to risk the worst case scenario. At the same time PBMs have incentive to limit costs. I think the market has normalized at this point and the market will largely correct itself:

1) Anybody with medicare/medicaid will probably be covered for the generic Epi regardless.

2) People without those and without commercial insurance are likely more price conscious, and with the whole EpiPen scandal doctors will likely know and promote the Adrenaclick for a cheaper fill for these patients.

3) People on commercial insurance will likely either have EpiPen covered or at least the generic version. Generic doesn't have the same copay offer but the price is much more reasonable under copays.

4) People with permissive insurance will find Auvi-Q covered at a ridiculous price to insurer, if they don't cover it under commercial insurance Kaléo will fill for free at direct delivery. They'll capture a smaller portion of the market due to less brand awareness. (I think this strategy will bite Kaléo in the a** in the end as there's no real incentive for PBMs to continue to fill Kaléo if they will fill scrips for free if they blacklist it, but that's another topic).

/endrant, sorry for the brain dump.

From Medscape - Another Look at the Cost of EpiPens

(Reuters Health) - Soaring prices and out-of-pocket costs for EpiPens to treat severe allergic reactions haven't halted a surge in the number of children and adults filling prescriptions for the devices, a U.S. study suggests.

Researchers who analyzed prescriptions filled by privately insured people found that out-of-pocket spending for EpiPens climbed 535% from 2007 to 2014. During that same period, annual EpiPen prescriptions almost tripled.

But the number of prescriptions filled by each patient barely changed. This suggests patients' costs rose due to price increases, not because people started using more EpiPens, said lead author Dr. Kao-Ping Chua, a public health researcher at the University of Chicago.

"For EpiPen in particular, failing to fill a prescription due to cost could mean the difference between life or death when serious allergic reactions occur - this is why Mylan's EpiPen price hikes are so ethically troublesome," Chua said by email.

Generic drugmaker Mylan obtained the rights to sell EpiPen in 2007. Since then, Mylan has increased the list price from $94 to $609, researchers reported March 27 online in JAMA Internal Medicine.

In part due to patient outcry over rising out-of-pocket spending, Mylan released a $300 generic EpiPen in December, the researchers note.

More recently, health insurance giant Cigna dropped coverage of the branded $600 EpiPens and drugstore chain CVS started selling a generic epinephrine injector from Lineage Therapeutics, Inc. for $110.

For the study, researchers examined data on people who receive private health insurance through more than 100 employers nationwide. They looked at co-payments, co-insurance, deductibles and total out-of-pocket spending.

From 2007 to 2014, patients' average annual out-of-pocket spending on EpiPen rose from about $34 to $75.

The proportion of patients with out-of-pocket costs of at least $100 climbed from 4% to 18% during the study period, while the share of patients with costs of at least $200 increased from 0.1% to almost 5%.

In October, Mylan agreed to pay the U.S. government $465 million after it was accused of falsely classifying the brand EpiPen as a generic medicine to reduce the size of the rebates it owed. Drugmakers pay rebates to Medicaid but they pay less money if a drug is a generic. Mylan didn't admit wrongdoing.

Mylan avoided paying $226 million in rebates on only two formulations of EpiPen from 2012 through 2016, according to a separate study in JAMA Internal Medicine. That suggests the total amount Mylan owed the government may far exceed what the company agreed to pay in the settlement, the authors write.

"High spending on prescription drugs on the part of public payors like Medicaid means that they have less to spend on coverage for other health benefits such as doctor's visits, hospitalizations and long-term care," said lead study author Dr. Jing Luo of Harvard Medical School and Brigham and Women's Hospital in Boston.

"They must either reduce covered healthcare services or reduce the number of eligible members and kick people off Medicaid," Luo said by email.

A Mylan spokesperson declined to comment on the Medicaid study beyond a statement made at the time of the settlement (here: http://bit.ly/2dLhDCA).

In January, Mylan said that about 90% of consumers who got its brand or generic EpiPen had an out-of-pocket cost of less than $50. During the same timeframe last year, 80% of patients paid less than $50 out-of-pocket, the company said.

SOURCE: http://bit.ly/2nYjF7y and http://bit.ly/2nYc2xL

JAMA Intern Med 2017.

Has there Beene muh of an update on this whole Mylan and EpiPen cost issue? Any efforts to truly lower the cost to patients? Not insurance loopholes, not discount cards, but actually lowering the full cost?

It seems to have fizzled out in the media and I don't really see and quantitative results.