VitalSigns: EpiPen alternatives appear to be gaining market share

Patients are flocking to alternatives to Mylan's EpiPen in the wake of the public relations disaster around the device's price, according to new data.

Other auto-injectors made up 28.9% of all epinephrine auto-injector prescriptions in February and 14.8% of prescriptions in January, a significant increase from last year, according to data from electronic health record vendor Athenahealth.

Last year, non-EpiPen devices generally represented 4.5% to 5% of all prescriptions, with a upsurge to over 7% of prescriptions in the fall when children were going back to school.

Source: athenaResearch

The timing makes sense: Mylan, the manufacturer of the EpiPen, released a generic version of the EpiPen in mid-December that costs half the price, while the original developer of the Auvi-Q brought the previously recalled “talking” auto-injector back to the market in late January at no cost for commercially insured patients, regardless of whether their insurers covered it. Some insurers are refusing to cover it, but at least half of the growth in non-EpiPen prescriptions came from Auvi-Q.

Also in January, Cigna announced that it was dropping coverage of the brand-name EpiPen in favor of Mylan's generic, and CVS Health announced that its pharmacies would sell the authorized generic version of Amedra Pharmaceuticals' Adrenaclick.

EpiPens are still the most popular product among prescribers, followed by Auvi-Q and scattered prescriptions for Adrenaclick, a less popular branded product, according to Anna Zink, senior associate at athenaResearch. The rest of the prescriptions are for generics.

Prescriptions for generic products are simply processed as “epinephrine auto-injector,” and EHR vendors don't have insight into which manufacturer's generic product was sold to the patient, said Dorrie Raymond, director of athenaResearch. For most generic drugs, patients don't generally have a choice—or care—about the manufacturer, and they're given what's in stock at the pharmacy.

But the various epinephrine auto-injectors each use slightly different delivery methods—an important issue for allergists who are training patients on device use—so it's worth watching whether doctors or patients work with pharmacies to request specific generic “brands.”

The hope is that more competitors in the auto-injector market could lead to lower prices and better access for Americans who need the lifesaving devices. Preliminary data show a 20% increase in prescriptions for auto-injectors this January compared to the same time last year, but Zink said it's too early to tell whether that's due to new devices entering the market.

Athenahealth's data is based on over 60,000 prescriptions for epinephrine auto-injectors to over 50,000 patients by over 1,400 providers writing prescriptions for auto-injectors since the beginning of 2016.