Patients usually don't get to choose a specific manufacturer's generic medication, and few care since generics should function identically regardless of manufacturer. And there are few situations where providers would care about the maker.
But as more generic epinephrine auto-injectors enter the market, providers and patients have more choices. Mylan's generic version of the EpiPen and Impax Pharmaceutical's generic version of Adrenaclick deliver epinephrine in slightly different ways, and patients who've traditionally used an EpiPen may prefer the familiarity of its generic version over the Impax generic.
Data from electronic health-record vendor Athenahealth shows that prescriptions for non-EpiPen auto-injectors, including generics, 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.
The new generics market will compete for allergy-prone patients who have long complained about the price of the brand-name EpiPen. There may even be another generic version of the EpiPen on the way from Israel-based Teva Pharmaceutical Industries, if it's able to overcome significant delays it has faced getting Food and Drug Administration approval.
The latest data don't show generics as gaining market share over any brand-name injector: the EpiPen is still the most popular product among prescribers, followed (in descending order of prescription volume) by the Auvi-Q – which is $0 for any commercially insured patient, regardless of whether their insurer covers it – Adrenaclick and the generic options. Athenahealth researchers can't break down prescriptions for generic products by manufacturer because prescriptions are simply processed as “epinephrine auto-injector,” and EHR vendors don't know which manufacturer's generic product was sold at the pharmacy.
So, if a prescriber or patient wanted to request a specific generic epinephrine auto-injector, could they? The nation's two biggest pharmacy chains say yes, they can.
While pharmacies often source generic medications from a single manufacturer, CVS Health and Walgreen Co. say they're offering both Mylan and Impax's generic versions. Both said doctors and patients can work with a pharmacist to request a specific generic product.
Walgreen spokesman Phil Caruso said that providers can specify a generic manufacturer, and the pharmacist will verify that choice with the patient. A patient could ask for the generic version if they're prescribed a brand-name product, he said. If a prescriber simply prescribes a generic “epinephrine auto-injector,” the pharmacy will defer to the patient's insurance formulary, he said.
When asked whether stocking multiple generic versions could be a competitive advantage over other pharmacies, he said that “we stock all products based on meeting the needs of our patients and providers.”
CVS Health spokeswoman Erin Britt wrote in an email that the Woonsocket, R.I.-based company is encouraging patients to ask their prescriber to write a prescription for an “epinephrine auto-injector,” which gives the pharmacist the opportunity to go over their options and costs for the assorted brand and generic devices. This suggestion comes in part because some providers may be tempted to refer to any auto-injector as an “EpiPen,” much like people often refer to facial tissue as “Kleenex,” regardless of brand.
CVS announced in January that it would offer the generic version of Adrenaclick for a cash price of $109.99 for a two-pack, which is significantly lower than its $649.99 cash price for EpiPen and the $339.99 cash price for the EpiPen generic. Additional savings are possible for qualifying patients through Impax's $100-off coupon program.
Britt said the differences between the various auto-injectors are “minor,” and CVS pharmacists are aware of those differences and the need to have patients understand them. “Patients require training to use any auto-injector device and can easily work either device,” she said.
Dr. Bob Lanier, a Fort Worth, Texas-based allergist, says he hasn't often told his patients to choose one generic device over the other and normally leaves that decision up to the pharmacist.
Lanier said he's open to training patients on either device, but noted that his patients might be more comfortable with the Mylan generic because his office has an EpiPen “trainer” device with no needle or medication, which they can test out and practice with before they get to the pharmacy. Nonetheless, he said he'd train patients on any product they bring to him.