10 ms·

CVS just announced a cheap generic alternative to the EpiPen

222 points by forrestbrazeal 10y ago

djschnei 10y ago
Look at that, even severely hindered capitalism can fill a market demand.
grabcocque 10y ago
Which isn't approved by the FDA so you can't buy.
oliwarner 10y ago
$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.
- gregmac 10y ago
  In Canada, brand name EpiPens are around $100 CAD each ($76 US), and are 100% covered by OHIP when prescribed by a doctor (who will give you a few if you want).
- jrnichols 10y ago
  > 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-2112662 http://www.ibtimes.com/how-us-subsidizes-cheap-drugs-europe-...
  - oliwarner 10y ago
    That these companies still make a huge profit here (after research).
deleted 10y ago
[deleted]
ianai 10y ago
This literally days after I plunked down the unearned income (aka credit card) for an epipen at cvs.
- toomuchtodo 10y ago
  Can you return it if unopened?
  - ceejayoz 10y ago
    Prescription medications can generally not be returned.
- dvdhnt 10y ago
  Perhaps your credit card has one of those perks where they'll refund the difference between paid and discounted price of a purchase within x number of days? Then again, it's probably like refunding the difference between two televisions; similar but not equivalent.
dtnewman 10y ago
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/2016/12/16/505851637/mylan-to-sell-generic-epipen-at-half-the-price-of-original http://www.npr.org/sections/health-shots/2016/12/16/50585163... [2] http://www.usatoday.com/story/money/nation-now/2016/08/29/brand-vs-generic-drugs-whats-difference/89534460/ http://www.usatoday.com/story/money/nation-now/2016/08/29/br...
- oddevan 10y ago
  Welcome to medicine. I grew up the child of a doctor, and she always, ALWAYS, bought the generic. They're required BY LAW to have the same "active" ingredients; you just might be paying for a slightly different pill shape, packaging, or taste.
  - dtnewman 10y ago
    As the second link I've referenced above points out, there's a possibility that two drugs have the same active ingredients but but they absorb differently. Or one company can have a pill and the other a tablet that dissolves in your mouth. But I imagine that the clinical difference is negligible or nonexistent in most cases. I almost always get generic when possible. But actually, one advantage of brand name drugs is that it could be easier to remember what they do. For example, sometimes I find old prescriptions in my medicine box (yeah, I don't have a good cabinet) and I don't remember what they are for. For example, I might see Zolpidem and and forget what is, but I'd be less likely to forget what Ambien is. But in general, this difference is worth very little to me and I usually get generics on principle.
7Z7 10y ago
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/dcbyjud?st=IXULGMDV&sh=b0daac4d https://www.reddit.com/r/news/comments/5njj2x/comment/dcbyju...
- gravypod 10y ago
  That was a very interesting video. Why was the AuviQ withdrawn?
  - 7Z7 10y ago
    Bridgewater, NJ - Sanofi US is voluntarily recalling all Auvi-Q® (epinephrine injection, USP). The recall involves all Auvi-Q currently on the market and includes both the 0.15 mg and 0.3 mg strengths for hospitals, retailers and consumers. This includes lot numbers 2081278 through 3037230, which expire October 2015 through December 2016.The products have been found to potentially have inaccurate dosage delivery, which may include failure to deliver drug. http://www.fda.gov/Safety/Recalls/ucm469980.htm http://www.fda.gov/Safety/Recalls/ucm469980.htm
    - gravypod 10y ago
      > which may include failure to deliver drug The way this sounds it's not mechanical but a software bug. How interesting. I'd love it if someone did some RE on these and found their failure mode.
gist 10y ago
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 10y ago
  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).
reacweb 10y ago
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.
- jstanley 10y ago
  You surely can't be arguing that they shouldn't be selling a cheaper version? And at this rate it only takes a couple more iterations of competition until the thing is almost free. Excellent, I say.
  - maxerickson 10y ago
    This is probably CVS partnering in paying for an expansion in manufacturing capacity (or promising to make some payments if they don't meet some sales goals) and is really a drop from $150 (the previous price point of generic Adrenaclick). I wouldn't count on further drops in price, at least not without other generics coming to market.
    - jstanley 10y ago
      "Other generics coming to market" is what I meant by "a couple more iterations of competition".
- alex_hitchins 10y ago
  Do you know how much it costs to produce the device and meet all the likely regulations? I would have thought this is to only break even. It's more a marketing move to be the good side in the story and get more business from ethical followers. Given the $600 of the original, I'd say $109 is cheap.
  - srtjstjsj 10y ago
    That's anchoring bias. It wasn't $600 2 years ago
kirillkh 10y ago
In other news: git just announced a cheap generic alternative to ObamaCare.
acomjean 10y ago
why aren't these things refillable? My understanding is that these need to be replaced yearly, but you replace the whole thing.
- maxerickson 10y ago
  The drug is sitting in front of a spring loaded plunger. So to refill it you have to release the tension and then correctly reset it. A mechanism that made it simple and reliable to do that would probably cost the same as throwing away the simpler mechanism. People that want to muss with vials and needles are free to do so anyway (you can buy epinephrine and needles for cheap if you aren't concerned about an easy to use and reliable auto-injector). The systematic failure is that the FDA granted Milan exclusivity for a simple improvement on a 30 year old product. The FDA should have the power to keep small improvements off the market when the innovator chooses not to license them. Of course this will outrage some people that believe in the freedom of companies to benefit from the patent system, but from a pragmatic standpoint the return to exclusivity was far more harmful to consumers than the simple improvement is beneficial.
- scottshea 10y ago
  Potential damage to the injector on each use makes it hard to guarantee a refill will work the same way.
  - camtarn 10y ago
    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 10y ago
      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..
refurb 10y ago
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-and-great-pbm.html http://www.drugchannels.net/2016/09/epipen-channel-economics...
- ceejayoz 10y ago
  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.
julienchastang 10y ago
Question: For non-USA residents reading this thread, how much do you pay for your Epipen?
- camtarn 10y ago
  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 10y ago
    How much does it cost the NHS?
    - stordoff 10y ago
      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-report-136427293 https://www.nice.org.uk/guidance/cg116/resources/costing-rep... 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-respiratory-system/34-antihistamines-hyposensitisation-and-allergic-emergencies/343-allergic-emergencies/anaphylaxis/adrenalineepinephrine/intramuscular-injection-for-self-administration/epipen https://www.evidence.nhs.uk/formulary/bnf/current/3-respirat...
- JorgeGT 10y ago
  Spain: from what I see in the official medicine list, it is commercialized under the name "Altellus" and costs 42,09€ [$44.77]: https://www.cofpo.org/index.php/medic-es.html?id=1128 https://www.cofpo.org/index.php/medic-es.html?id=1128
nitrogen 10y ago
The headline's inclusion of the word "just" seems like clickbait. It feels like they are trying to mimic break room gossip.

222 points by forrestbrazeal 10y ago

djschnei 10y ago

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

grabcocque 10y ago

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

oliwarner 10y ago

$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.

gregmac 10y ago
In Canada, brand name EpiPens are around $100 CAD each ($76 US), and are 100% covered by OHIP when prescribed by a doctor (who will give you a few if you want).
jrnichols 10y ago
> 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-2112662 http://www.ibtimes.com/how-us-subsidizes-cheap-drugs-europe-...
- oliwarner 10y ago
  That these companies still make a huge profit here (after research).

deleted 10y ago

[deleted]

ianai 10y ago

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

toomuchtodo 10y ago
Can you return it if unopened?
- ceejayoz 10y ago
  Prescription medications can generally not be returned.
dvdhnt 10y ago
Perhaps your credit card has one of those perks where they'll refund the difference between paid and discounted price of a purchase within x number of days? Then again, it's probably like refunding the difference between two televisions; similar but not equivalent.

dtnewman 10y ago

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

oddevan 10y ago
Welcome to medicine. I grew up the child of a doctor, and she always, ALWAYS, bought the generic. They're required BY LAW to have the same "active" ingredients; you just might be paying for a slightly different pill shape, packaging, or taste.
- dtnewman 10y ago
  As the second link I've referenced above points out, there's a possibility that two drugs have the same active ingredients but but they absorb differently. Or one company can have a pill and the other a tablet that dissolves in your mouth. But I imagine that the clinical difference is negligible or nonexistent in most cases. I almost always get generic when possible. But actually, one advantage of brand name drugs is that it could be easier to remember what they do. For example, sometimes I find old prescriptions in my medicine box (yeah, I don't have a good cabinet) and I don't remember what they are for. For example, I might see Zolpidem and and forget what is, but I'd be less likely to forget what Ambien is. But in general, this difference is worth very little to me and I usually get generics on principle.

7Z7 10y ago

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

gravypod 10y ago
That was a very interesting video. Why was the AuviQ withdrawn?
- 7Z7 10y ago
  Bridgewater, NJ - Sanofi US is voluntarily recalling all Auvi-Q® (epinephrine injection, USP). The recall involves all Auvi-Q currently on the market and includes both the 0.15 mg and 0.3 mg strengths for hospitals, retailers and consumers. This includes lot numbers 2081278 through 3037230, which expire October 2015 through December 2016.The products have been found to potentially have inaccurate dosage delivery, which may include failure to deliver drug. http://www.fda.gov/Safety/Recalls/ucm469980.htm http://www.fda.gov/Safety/Recalls/ucm469980.htm
  - gravypod 10y ago
    > which may include failure to deliver drug The way this sounds it's not mechanical but a software bug. How interesting. I'd love it if someone did some RE on these and found their failure mode.

gist 10y ago

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 10y ago
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).

reacweb 10y ago

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.

jstanley 10y ago
You surely can't be arguing that they shouldn't be selling a cheaper version? And at this rate it only takes a couple more iterations of competition until the thing is almost free. Excellent, I say.
- maxerickson 10y ago
  This is probably CVS partnering in paying for an expansion in manufacturing capacity (or promising to make some payments if they don't meet some sales goals) and is really a drop from $150 (the previous price point of generic Adrenaclick). I wouldn't count on further drops in price, at least not without other generics coming to market.
  - jstanley 10y ago
    "Other generics coming to market" is what I meant by "a couple more iterations of competition".
alex_hitchins 10y ago
Do you know how much it costs to produce the device and meet all the likely regulations? I would have thought this is to only break even. It's more a marketing move to be the good side in the story and get more business from ethical followers. Given the $600 of the original, I'd say $109 is cheap.
- srtjstjsj 10y ago
  That's anchoring bias. It wasn't $600 2 years ago

kirillkh 10y ago

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

acomjean 10y ago

why aren't these things refillable? My understanding is that these need to be replaced yearly, but you replace the whole thing.

maxerickson 10y ago
The drug is sitting in front of a spring loaded plunger. So to refill it you have to release the tension and then correctly reset it. A mechanism that made it simple and reliable to do that would probably cost the same as throwing away the simpler mechanism. People that want to muss with vials and needles are free to do so anyway (you can buy epinephrine and needles for cheap if you aren't concerned about an easy to use and reliable auto-injector). The systematic failure is that the FDA granted Milan exclusivity for a simple improvement on a 30 year old product. The FDA should have the power to keep small improvements off the market when the innovator chooses not to license them. Of course this will outrage some people that believe in the freedom of companies to benefit from the patent system, but from a pragmatic standpoint the return to exclusivity was far more harmful to consumers than the simple improvement is beneficial.
scottshea 10y ago
Potential damage to the injector on each use makes it hard to guarantee a refill will work the same way.
- camtarn 10y ago
  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 10y ago
    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..

refurb 10y ago

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-and-great-pbm.html http://www.drugchannels.net/2016/09/epipen-channel-economics...

ceejayoz 10y ago
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.

julienchastang 10y ago

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

camtarn 10y ago
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 10y ago
  How much does it cost the NHS?
  - stordoff 10y ago
    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-report-136427293 https://www.nice.org.uk/guidance/cg116/resources/costing-rep... 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-respiratory-system/34-antihistamines-hyposensitisation-and-allergic-emergencies/343-allergic-emergencies/anaphylaxis/adrenalineepinephrine/intramuscular-injection-for-self-administration/epipen https://www.evidence.nhs.uk/formulary/bnf/current/3-respirat...
JorgeGT 10y ago
Spain: from what I see in the official medicine list, it is commercialized under the name "Altellus" and costs 42,09€ [$44.77]: https://www.cofpo.org/index.php/medic-es.html?id=1128 https://www.cofpo.org/index.php/medic-es.html?id=1128

nitrogen 10y ago

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