EpiPen price hikes hit home in Central Montana
The EpiPen price hikes have been plastered across national news outlets, with stories ranging from the cost to the reasons to the reactions. But as is often the case, national headlines have been hard to relate to here in rural Montana. So the question is, has the price hike had an effect here?
What it means for families
The most obvious place to look is at the individual consumer: a person with an allergy strong enough to trigger anaphylaxis.
According to the Mayo Clinic’s website, anaphylaxis boils down to a severe allergic reaction. The immune system overreacts, releasing chemicals that can cause nausea, trouble breathing and skin rashes. A serious attack can stop a person’s breathing or their heart.
The medicine in an EpiPen, epinephrine or epi for short, is used to treat anaphylaxis. Mayo Clinic writes that it “reduces your body’s allergic response.” The reduction can create enough extra time to reach medical facilities.
In Joe Gaylord’s case, the pens would buy extra time for his children. He and his wife live out by Grass Range, and three of their five children have had allergic reactions. Only one outgrew his allergies.
The allergy diagnoses started with the Gaylords’ first child. She was born in Alaska, and the remote location led to extra precautions they eventually applied to their whole family.
The couple has annual blood work done for the five kids, a policy started after their first baby developed allergies. Teaching in a remote Alaskan village created the habit of preparing a medicine kit. The stockpile was refilled every year during visits to more urban areas, making sure necessities were on hand and not expired. This included EpiPens, one for every child with active allergies.
The couples’ insurance, with a 10 percent co-pay, made the practice affordable when the two started it eight or nine years ago. The Gaylords continue their annual EpiPen purchases, but now the cash register total is a little different.
“Our first EpiPen I think was around $50, so we paid less than $5 for our co-pay” Gaylord said. “The last one was over $700.”
Aware of the price hike, the parents bought the last batch before their Alaskan insurance ended. The couple plans to continue the habit, but they do have a backup of sorts.
“We have a lot of EpiPens around because we keep them,” Gaylord explained. “They’re expensive.”
The most current ones are kept in areas the children frequent most. The expired pens, if they’re not cloudy, are most other places the children may go.
Others affected, too
But what if you don’t personally have a severe allergy? Or what if your insurance made your EpiPen affordable? If you live in rural Montana, you or your loved ones may still feel the effect, just in an ambulance instead of your home.
EMS services in rural Montana are available, but stretched: Judith Basin County covers 1,971 square miles, all serviced by three ambulances. Volunteers make up the entire EMS force, and the nearest hospital is in the next county.
Suzanne Aune, Judith Basin’s EMS coordinator, said the ambulances in Stanford, Geyser and Hobson used to stock the EpiPens. Now they use syringes and vials of pure epinephrine to treat anaphylaxis, a method that requires a certain level of training.
“We are 100 percent volunteer,” Aune said. “The majority are AEMTs, which are advanced, and the rest are EMTs. The advanced have more advanced skills: We can do medications, we can start and maintain IVs, we can establish advanced airways.”
Although the medications, and so the switchover, were provided by Central Montana Medical Center, Aune can see the reasons behind it.
“It’s cost prohibitive using the EpiPens,” she said, later explaining, “Part of it is we carry them on our rigs, they expire and we get absolutely zero dollar use out of it.”
Petroleum County, whose ambulance director is a CMMC doctor, has the same experience with its two ambulances.
“We carry what they call IV, or intravenous, epi,” EMT William Cassell said. “We use to carry autoinjectors, but they’re $400 a whack.”
Cassell has been part of Petroleum EMS for 6 years, and became an EMT in 2012. Although he is not an advanced EMT, he has an endorsement to administer medicine. He said almost every EMS member can give the IV epinephrine, and many of them trained to do so when they switched from EpiPens. Why?
“With the limited number of calls, and having a $400 vial of autoinjector epi, and then another $400 of juvenile’s autoinjector epi: You’re talking $800 of stuff that, 99 percent of the time, expires,” he said.
Cassell added the increased cost to an ambulance service transfers to patients, too.
“It’s also one of those things that drives up the cost of the call,” he said. “Medical costs are directly related to drug costs.”
What’s the alternative?
The switch from EpiPens to epinephrine vials and their accompanying syringes did not originate at CMMC. The change came down from the state.
State EMS Medical Director Dr. Harry Sibold, in an email to the News-Argus, wrote medical and EMS fields had been watching EpiPen prices since roughly 2007. While the news has focused on individual patients, he said most people don’t realize emergency providers have been using EpiPens to treat anaphylaxis, too.
The change to epinephrine vials came in 2014, according to Sibold. An individual medical director requested the switch. Seeing a chance to make a broader change that saved money without cutting corners, the Montana Board of Medical Directors had the idea researched. On a positive recommendation from the research committee, they approved a statewide change.
Now Montana’s EMTs and paramedics with the required training are allowed to use vials instead of EpiPens. Sibold said the change was necessary, especially with EpiPens reaching as much as $600-$800 for a two pack.
“A specific impetus for change was that, though this is an infrequently used device, it is critically important that emergency providers have this available to administer when serious anaphylaxis is encountered,” he said.
However, Sibold cautioned that the EMS solution to price hikes was not a good alternative for everyone.
“Though the option of using epinephrine from a vial by the public is available, and not prohibited, there are risks that make this a less desirable choice than an autoinjector,” he said
Sibold explained the stress of an emergency situation could lead to mistakes in giving a vial-and-syringe treatment. He said people could give an incorrect dose, or administer the shot to the wrong part of the body, a potentially fatal error.
That is the draw of an EpiPen, according to CMMC Ambulance Services Manager Rick Poss.
“That’s why the EpiPen is popular,” he said. “It’s pre-dosed: the patient can just flip the lid.”
He also understands the price attraction: the vials his service use cost the hospital roughly $1.50. But Poss agrees with Sibold, and doesn’t recommend the method. In the end, he shares the frustrations of the patients.
“I have no idea why it should be that expensive,” he said. “The autoinjector itself is not new at all and epinephrine has been around since the 1900s.”
Info box: EpiPen, the basics
• Coupon: Covers up to $300 out-of-pocket co-pay expense for an Epi-Pen two pack. Does not apply to uninsured customers.
• Schools: Schools can apply to receive four free EpiPens, or two two packs. The school does need to have a prescription to apply.
The local price (without insurance)
*Adult dose = .3 mg = 3 mL
• EpiPen/EpiPen Jr.: $650 for two
• Generic autoinjector (adult and child): about $400 for two
• Epinephrine vial: Unavailable from Shopko’s wholesaler
Albertsons’ Osco Pharmacy
• EpiPen/EpiPen Jr.: $550 for two
• Generic autoinjector (adult and child): about $300 for two
• Epinephrine vial: more than $400 for 25 1-mL vials, $80-$90 for one 30-mL vial
• EpiPen/EpiPen Jr.: $618 for two
• Generic autoinjector: $465 for two adult doses, $477 for two child doses
• Epinephrine vial: about $125 for one 30-mL vial