Bill would open door for EpiPen substitutes
HEALTH CARE /
In an effort to deal with the skyrocketing cost of potentially life-saving EpiPens, Ohio is looking at allowing pharmacists to substitute cheaper alternatives.
The cost of EpiPens, the most common brand of epinephrine auto-injectors, became an issue in last year’s presidential campaign. Mylan Pharmaceuticals, which controls most of this market, came under fire for gradually raising the retail price more than 400 percent to $600 for a two-pen pack.
These are carried as a precaution to counter anaphylactic reaction to food and other allergies, and the pens must be replaced at the rate of about one a year. Currently, Ohio does not authorize a pharmacist to substitute a generic or alternative brand with a fraction of the price tag when a doctor writes “EpiPen” on a prescription.
“Mylan has a virtual monopoly on the market,” said Rep. Derek Merrin, R-Monclova Township, who introduced a bill this week. “Many physicians are not even aware that pharmacists do not have the ability to do substitutions.”
He said he sees his bill as a national model, a “free market solution” to the Mylan pricing issue.
“We’re basically debating drug delivery,” said state Sen. David Burke, R-Marysville, the only pharmacist in the General Assembly. His district stretches as far north as Sandusky Bay.
He said he knows of no instance where substitution of the drug, as delivered through a different spring mechanism than used in the Mylan product, has caused harm.
Under the bill, substitution could be done only with the patient’s permission. Doctors could still insist on the brand-name EpiPen by specifying no substitutions on prescriptions.
House Bill 101, the Epinephrine Accessibility Act, would also require the Ohio Board of Pharmacy, working with the State Medical Board, to develop a process through which pharmacists could dispense epinephrine auto-injectors without needing new prescriptions each time.
This is similar to what Ohio has done in recent years to expand access to naloxone, sold under the brand name Narcan. Syringes are carried to counter the effects of narcotic drug overdoses.
“Both are life-saving medications,” Merrin said. “Epinephrine auto-injectors are like fire extinguishers for severe allergies. You don’t need to run to the fire department every single year to have a fire extinguisher. A grown adult shouldn’t have to be given permission to have life-saving medication at their disposal when they need it.”
While Mylan came under fire by Congress for the price of its EpiPen two-pack, it has provided the drug at lower prices in some cases through its discount programs. Although in the minority, there are other brand-name and generic alternatives on the market.
While doctors could avoid the higher cost for patients by generally prescribing an epinephrine autoinjector rather than the specific brand name, Burke said that doesn’t happen often. The brand name has almost become the generic term, much in the way that people ask for Kleenex instead of facial tissue.
“All we’re concerned about is are we giving the same dose to the correct person,” Burke said. “We don’t care what the spring mechanism inside the auto injector looks like.”
The state recently enacted a law expanding the list of public places that could keep on hand epinephrine auto-injectors that have not been prescribed for a specific patient in case of emergency. Schools, colleges and universities, youth camps, restaurants, amusement parks, sports arenas, day-care centers, and other venues are now among those granted some civil protection when using the auto-injectors.