
CVS just announced a cheap generic alternative to the EpiPen - forrestbrazeal
http://arstechnica.com/science/2017/01/cvs-just-announced-a-super-cheap-generic-alternative-to-epipen
======
7Z7
From reddit:

 _Clarification here, CVS cut the retail price of the existing generic for
Adrenaclick (known as Epinephrine)._

 _This generic has been around for a while, but isn 't an A/B rated generic so
it's illegal for a pharmacy to dispense this if a prescription is written for
EpiPen. We can dispense this if a prescription is written for Adrenaclick or
Epinephrine._

 _Make sure your doctor writes a script for Adrenaclick or it is illegal for
us to dispense this cheaper generic to you_

 _Edit: The injection device of each product is what limits the A /B rating.
Adrenaclick and EpiPen have different autoinjector systems. Yes the
regulations are that strict. Here's[0] a video showing the difference between
Adrenaclick, Epipen, and AuviQ (which has been recalled and discontinued)._

[0]
[https://www.youtube.com/watch?v=LRgqwgCh4Fs](https://www.youtube.com/watch?v=LRgqwgCh4Fs)

[https://www.reddit.com/r/news/comments/5njj2x/comment/dcbyju...](https://www.reddit.com/r/news/comments/5njj2x/comment/dcbyjud?st=IXULGMDV&sh=b0daac4d)

~~~
gravypod
That was a very interesting video. Why was the AuviQ withdrawn?

~~~
ci5er
Quality Control issues. There's an interesting post about the whole Epipen
fiasco here: \- [http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-
dr...](http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs-
chairs/)

The author's first comment (the first response to the first comment) is (to
me) also interesting...

~~~
maxerickson
That's kind of a fun juxtaposition there. A product withdrawn because it
didn't work and a rant about complex regulation of products that consumers
expect to be 100% reliable.

~~~
Symmetry
And the FDA was right to withdraw it. But the only reason it was around in the
first place was that it was a sophisticated but also relatively complicated
improvement on the EpiPen. It's Europe's 8 different brands that are basically
just as simple as an EpiPen that the author really wants in the US.

------
dtnewman
This is unbelievable. The first line says:

 _" Pharmaceutical giant CVS announced Thursday that it has partnered with
Impax Laboratories to sell a generic epinephrine auto-injector for $109.99 for
a two-pack—a dramatic cut from Mylan’s Epipen two-pack prices, which list for
more than $600 as a brand name and $300 as a generic."_

It seems that Mylan, the owner of the Epipen brand, was getting criticized
about their outrageous prices [1] so they put out a "generic" version of their
own product. Unless I'm missing something, that means that until now, the
company that makes the brand name drug and artificially inflates the price
(and blames it on insurance companies) _also made the only generic version of
the product_. Given that it's the same company making the brand name and the
generic, I assume that they must be equivalent products (am I missing
something?), so they are literally just charging an additional $300 for the
brand. Why would any patient or insurance company in their right mind pay for
the brand name in this case? (this question can be asked more widely about
brand name vs generic drugs... but in this case, it has literally been the
same company making them. So it's hard to claim that there's even a minor
difference, unless the company specifically manufactured them differently,
which seems unlikely. For example, some generic drugs could have the same
active ingredients, but absorb differently [2]. But it's hard to imagine that
being the case for an injection).

In any case, it's nice to see that a true competitor is finally entering this
market.

[1] [http://www.npr.org/sections/health-
shots/2016/12/16/50585163...](http://www.npr.org/sections/health-
shots/2016/12/16/505851637/mylan-to-sell-generic-epipen-at-half-the-price-of-
original) [2] [http://www.usatoday.com/story/money/nation-
now/2016/08/29/br...](http://www.usatoday.com/story/money/nation-
now/2016/08/29/brand-vs-generic-drugs-whats-difference/89534460/)

~~~
mikeash
A lot of people want the brand name because they think it might be better.
They don't do the research and they don't want to take any risk with their
health, so they just pay for the brand name. Sometimes this is a reasonable
choice (as you say, not all generics are exactly equivalent) and sometimes
it's not. People who won't do the research won't know which case they're in.

As for insurance companies, they're probably paying far less than the listed
price, and have either negotiated it down to be the same as the generic (why
not, it costs the same to make) or got close enough and are willing to absorb
some extra cost in order to attract people who think it matters.

~~~
AtheistOfFail
> brand name because they think it might be better

There's also the "death problem". No customer likes to cut corners on
something to save their life.

~~~
mikeash
Yeah, that's what I meant, but the way you put it better emphasizes _why_
people act this way.

------
refurb
It's important that people realize that although Epipen's _list price_ was
$600, the company saw only about 50% of that. The rest of it was absorbed by
the channel as it made it's way to the consumer. Most of those dollar were
rebated to the PBMs.[1]

You might ask, why raise the price 15% and rebate back 13%, when you could
just raise the price 2%? Well, the PBMs can go back to insurers and say "look!
I successfully negotiated a 13% discount for you! All those fees you pay us
are worth it!". So the drug companies play along.

If you look at list prices for drugs, they went up 12.4% in 2015, but the _net
prices_ only went up 2.8%[1].

[1] [http://www.drugchannels.net/2016/09/epipen-channel-
economics...](http://www.drugchannels.net/2016/09/epipen-channel-economics-
and-great-pbm.html)

~~~
ceejayoz
How much is absorbed by middlemen seems like a bit of a red herring. _Mylan_
raised the price of the pens from $100 in '07 to $600 this year. Hard to blame
that on pharmacies and wholesalers taking their cut.

------
reacweb
IMHO, calling it cheap is very exaggerated. It is already expensive at $109.99
compared to the simplicity of the product and the low cost of production and
research. At $600, it was insane.

~~~
kmm
In Belgium they cost about 40 euros (and of course is covered by health care).
I can't imagine the manufacturing cost to be much higher, even taking into
account the way higher standards for medical equipment. The epinephrine itself
is dirt cheap.

~~~
zwerdlds
Sounded like $109 was for a 2-pack. Is that Belgian price maybe a single?

~~~
kmm
Ah, right, that makes sense. About the same price then.

------
oliwarner
$100 is still outrageously expensive for something that is absolutely
essential for some people.

The NHS in the UK pays £52 ($90?) for a two pack of branded EpiPens. Singles
of "generics" are available for £26. They are made available to anybody who
needs one either for free or the £8 prescription fee.

Get it together, America.

~~~
jrnichols
> The NHS in the UK pays £52 ($90?) for a two pack of branded EpiPens.

And who's to say that our high prices aren't subsidizing your low cost.

[http://www.ibtimes.com/how-us-subsidizes-cheap-drugs-
europe-...](http://www.ibtimes.com/how-us-subsidizes-cheap-drugs-
europe-2112662)

~~~
oliwarner
That these companies still make a huge profit here (after research).

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nitrogen
The headline's inclusion of the word "just" seems like clickbait. It feels
like they are trying to mimic break room gossip.

------
ianai
This literally days after I plunked down the unearned income (aka credit card)
for an epipen at cvs.

~~~
toomuchtodo
Can you return it if unopened?

~~~
ceejayoz
Prescription medications can generally not be returned.

------
gist
Note also that if it is cheap enough people will buy more than they need and
keep them laying around in various places.

(I buy portable hard drives like water anyone who remembers way back how
expensive they were knows what that feels like. Ditto for computers you use to
have one now I have lost count.)

~~~
carbocation
Epinephrine in these autoinjectors degrades relatively quickly (over the
course of months). It's good to have more epi-pens laying around, but the
expiration makes this a different situation from HDDs (though they, too, have
an expiration but usually on a longer time horizon).

------
julienchastang
Question: For non-USA residents reading this thread, how much do you pay for
your Epipen?

~~~
camtarn
Free in the UK due to the NHS - however, the NHS is reluctant to prescribe
them unless there's a good chance of anaphylactic shock or life-threatening
breathing difficulty, because the pens are expensive, go out of date quickly,
and usually need to be issued 2-4 at a time.

~~~
adventured
How much does it cost the NHS?

~~~
stordoff
Estimates from 2011:

> The health economics model assumes that people who receive adrenaline auto-
> injectors will be allocated two epinephrine pens (EpiPens) with an average
> shelf-life of 6 months. Each auto-inject EpiPen costs the NHS £28.77
> (British national formulary 60). This equates to £115.08 per person per
> year.

[https://www.nice.org.uk/guidance/cg116/resources/costing-
rep...](https://www.nice.org.uk/guidance/cg116/resources/costing-
report-136427293)

Edit: Current cost to the NHS appears to be:

> net price 2-mL auto-injector device = £26.45, 2 × 2-mL auto-injector device
> = £52.90

[https://www.evidence.nhs.uk/formulary/bnf/current/3-respirat...](https://www.evidence.nhs.uk/formulary/bnf/current/3-respiratory-
system/34-antihistamines-hyposensitisation-and-allergic-
emergencies/343-allergic-
emergencies/anaphylaxis/adrenalineepinephrine/intramuscular-injection-for-
self-administration/epipen)

------
acomjean
why aren't these things refillable?

My understanding is that these need to be replaced yearly, but you replace the
whole thing.

~~~
scottshea
Potential damage to the injector on each use makes it hard to guarantee a
refill will work the same way.

~~~
camtarn
I'm guessing the parent was asking about refilling due to the active
ingredient expiring, not after an actual injector use. Hopefully most people
who have epi-pens have to replace them due to expiry rather than due to
frequently having to use them.

Replacing the pen after actually using it seems entirely reasonable - if
nothing else, the needle will be contaminated.

~~~
acomjean
Thats what I was asking.

I was thinking of inhalers for asthma. The plastic bit is cheap enough, but
they could in theory just give you the medicine filled part.

My understanding is the medicine in these epi-pens is fairly inexpensive..

~~~
jrnichols
> My understanding is the medicine in these epi-pens is fairly inexpensive..

an ampule of 1:1000 epinephrine is about $4. At least that's the price we pay
for them on the ambulance. I'm a Paramedic in the US, and we took the Epi-Pens
off our units ages ago due to the ridiculous costs. Now we just draw up epi by
hand with a typical insulin syringe and deliver it that way.

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djschnei
Look at that, even severely hindered capitalism can fill a market demand.

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grabcocque
Which isn't approved by the FDA so you can't buy.

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kirillkh
In other news: git just announced a cheap generic alternative to ObamaCare.

