8 trips to pharmacies in the past 7 days, plus a few phone calls

Things I’ve learned about epinephrine autoinjectors over the past 7 days:

The market leader is EpiPen, made by Mylan. Every drugstore stocks them, every doctor prescribes them.

The biggest competitor was Auvi-Q, made by Sanofi, which had some real advantages. It was a different shape, hurt a bit less to use, and had nifty talking instructions that helped make it more foolproof. It was recalled last October, and is not yet back on the market. Not every pharmacy knows that it was recalled, and you may still run into a pharmacy that insists that it’s the only alternative to EpiPen, insists that it wasn’t recalled, and is stunned to find that it’s not on their shelf. I’m looking at you, local CVS.

An alternative used to be Adrenaclick. It was pulled from the market in 2014, but the Auvi-Q recall notice states that it is still available as an alternative. It isn’t.

What is “available” is a generic epinephrine autoinjector, with no brand name at all. It’s made by the same company that made Adrenaclick, though they seem to use a different company name for the generic to make things simpler. Many pharmacies insist that the generic does not exist. I have a trainer for it in my hand that was mailed to me last week, but it does not exist. It is supposed to be available to pharmacies from their wholesalers, and insurance companies have pricing for it. I have a prescription for it, but I cannot get it filled. The Auvi-Q recall notice does not acknowledge the existence of the generic.

None of these auto-injectors are considered equivalent, even though they all contain identical medication. A prescription for Auvi-Q is therefore currently useless, because the pharmacy cannot substitute EpiPen for Auvi-Q.

A pharmacy might be able to substitute generic epinephrine autoinjector for Adrenaclick, since they are the exact same device. But first the pharmacy would have to acknowledge that generic epinephrine autoinjector exists.

Many prescriptions for medications are for 30 day supplies. That’s a difficult way of looking at EpiPen, since EpiPen is an emergency medication. We need a bunch so we can leave one at home, take one with us, leave one at preschool, etc. Then we don’t need any for a year, unless we use one and have to immediately replace it.

For most medications that are 30 day supplies, Cigna allows you to refill every 23 days. Cigna allows you to buy 2 boxes of EpiPens at one time, and then makes you wait. But unlike with most other medications, Cigna allows you to refill EpiPens every 2 days. Cigna can also do overrides on the refill limits for various reasons.

For most medications that are 30 day supplies, MassHealth allows you to refill every 24 days. MassHealth allows you to buy 2 boxes of EpiPens at one time, and then makes you wait. But unlike with most other medications, MassHealth allows you to refill EpiPens every 3 days. MassHealth cannot do any overrides on refill limits for any reason. Unless maybe they can if a pharmacist calls the DUR office, but probably not.

EpiPen’s price with Cigna is currently around $550 per box. This is up from $300 per box a couple of years ago, and $100 per box a few years before that.

The generic epinephrine autoinjector is under $400 per box. Cigna will happily pay for either EpiPen or the generic without prior authorization. MassHealth requires prior authorization for the generic, but not for EpiPen.

It’s not clear whether EpiPens and the generic are considered separate drugs or the same in terms of setting quantity limits and calendar limits on filling prescriptions. If you just bought two boxes of EpiPens and would have to wait to buy more, would you also have to wait to buy generics? I don’t know what the answer is, nor what the answer should be. I might try to find out tomorrow.

As of early January 2016, EpiPen expiration dates are pretty consistently February 2017 at both Walgreens and CVS around here.

EpiPen is available in 0.15 or 0.3 dose strengths. The smaller one is called EpiPen Jr., and is for kids under 66 pounds. The larger one is for everyone 66 pounds and up. If you have a prescription for the larger one by mistake, Cigna doesn’t mind if you fill it for a 4-year-old. MassHealth, however, rejects it. It’s not clear what would happen if the larger one were not a mistake.

It’s not clear whether the two dose strengths are considered separate drugs or the same in terms of setting quantity limits and calendar limits on filling prescriptions.

Since our pharmacy deductible is combined with our medical deductible this year, and since EpiPen is $550 per box, David’s $2600 annual deductible is now met as of January 11. Whee.