Epinephrine auto-injectors are devices used to deliver life-saving medication called epinephrine. It is injected directly into the muscle of the thigh during a severe allergic reaction known as anaphylaxis. The drug epinephrine (also known as adrenaline) treats anaphylaxis by slowing the progression of the allergic response. Through increasing blood pressure, it decreases swelling. This effect allows the airway muscles to relax, improving the breathing of the person with an allergic reaction.

Epinephrine was first discovered in the early 1900s by a Japanese-American biochemist. Shortly after the discovery, scientists figured out a way to produce epinephrine in a lab. They were able to make large quantities at a cheap price. Originally, medical professionals used epinephrine  to treat a variety of ailments. But with time, doctors focused on using the drug to treat anaphylaxis and severe cases of asthma in hospitals. By 1987, the FDA approved an effective design to deliver the drug outside of hospitals: the EpiPen. This design is an auto-injector pre-filled with a dosage of epinephrine, which allows for a quick and easy delivery. In the case of anaphylaxis, time is incredibly important. With the auto-injector, you do not have to be a medical professional to know how to use it. This buys you time to seek proper medical care.

The Epinephrine Auto-Injectors

EpiPen is just one of the many brands of epinephrine auto-injectors. Some other brands include Adrenaclick, Auvi-Q, and the recently FDA approved authorized generic.”Regardless of brand, people with severe allergies must carry an epinephrine auto-injector with them at all times to protect them from potential allergic reactions. However, some of the newer brands had problems that have contributed to the popularity and preference of the name brand EpiPen. Auvi-Q was recalled for dosage concerns and Twinject, another brand, has been discontinued. As the first established auto-injector on the market, EpiPen has become trusted by doctors and consumers over some of the other brands. Similar to how the brand name Kleenex has become synonymous with tissues, EpiPen has become interchangeable with epinephrine auto-injectors. 

The Cost of Epinephrine

However, access to this essential product has become more difficult as EpiPen prices have continued to rise, notably after Mylan acquired EpiPen. In 2007 an EpiPen package of 2 cost $100, while today it costs more than $650. These high prices are frustrating for people with allergies because it is a necessity in their everyday life. High prices also have a profound impact because the product expires after 18 months from the time of manufacture. This means that even if people with allergies do not need to use the medication, which hopefully they do not, they still have to purchase a new dose every year and a half; the cost really adds up. 

To address the rising prices of this essential medicine, Illinois State Representative, Jonathan Carroll fought to pass a law in his state. House Bill 3435 ensures insurance companies cover the costs for kids who need epinephrine auto-injectors. The legislation went into effect in January 2020 and was an important measure to expand access to affordable life-saving medicine. After continuous price hikes, the law makes sure that no child in Illinois is without an epinephrine auto-injector because they could not afford it. Legislation like House Bill 3435 are part of a state by state movement, in which advocates are fighting to pass food allergy laws in each state to help improve epinephrine accessibility. 

A Class Action

In 2016, several class-action lawsuits were filed against the companies that make and market EpiPens, Mylan and Pfizer. The lawsuit alleged that EpiPen used various anticompetitive strategies to monopolize the epinephrine auto-injector market, which resulted in raised EpiPen prices by 500% between 2008 and 2016. One of the alleged practices was that they offered kickbacks to pharmacy benefit managers and insurers, which allowed EpiPen to gain preferential treatment over its competitors, thus raising its prices. The suit also claimed that Mylan provided free or discounted EpiPens to schools in exchange for exclusive contracts. This prohibited business with other epinephrine-auto injector brands, giving EpiPen a monopoly.

The long-standing case may soon come to a resolution. Pfizer and two other companies have agreed to a settlement in which they would pay $345 million to end the litigation.

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