Staying in the know about EpiPen alternatives in 2017

Auvi-Q returns in the new year, but will it do anything for epinephrine auto-injector pricing?

Most pharmacists have probably already heard the news that the maker of the Auvi-Q epinephrine auto-injector will bring the product back to market in early 2017.

With the past months dominated by the controversy over EpiPen’s high price tag, health care providers may be wondering what this might mean for costs of epinephrine auto-injector products for consumers going forward.

Maria Miller Thurston, PharmD, BCPS, a clinical assistant professor at Mercer University College of Pharmacy, said it’s hard to say at this point.

When Auvi-Q was on the market, she said it wasn’t prescribed as often as the EpiPen product. Even so, prices for both products were about the same: $500–$600 for a two-pack without private insurance (even when patients have insurance, copays can be costly).

The CEO of Kaléo, Auvi-Q’s maker, told Physician’s First Watch that the company was still “working with stakeholders” to set the price and that “the most important price is the price to the patient.”

Auvi-Q’s added novel auto-injector technology of being able to prompt users through the administration process might also factor into price, according to Thurston.

If prices still remain an issue for consumers with EpiPen and now the Auvi-Q product, there’s still the option of prescribing an alternative product: The “generic” version of the Adrenaclick product is the epinephrine auto-injector. However, pharmacists cannot generically substitute this product because FDA doesn’t consider the device to be therapeutically equivalent to the EpiPen—which makes it essential that prescribers indicate epinephrine auto-injector, not EpiPen, on the prescription. This is something that often slips by because EpiPen has become the accepted general term for an epinephrine auto-injector.

Thurston said prior to the controversy over EpiPen’s high price, many prescribers, providers, and even pharmacists weren’t very aware of the Adrenaclick alternative. But she says—at least in her experience—that seems to have changed recently.

“In our practice in outpatient internal medicine, we do the prescribing here and our residents and physicians are now much more aware of the fact that they need to write in epinephrine auto-injector and not EpiPen,” Thurston told Pharmacy Today.

Robert Younger, MD, FAAAAI, from Asthma, Immunology & Allergy Associates in Chattanooga, TN, said his prescriptions for EpiPen now all say “may substitute” due to the financial hardship that EpiPen pricing causes for paying individuals and families. He would also like to see more pharmacies stocking the generic Adrenaclick epinephrine auto-injector.

Pharmacists should continue to educate prescribers, patients, and other pharmacists about the generic product and that the prescription needs to indicate epinephrine auto-injector, and not EpiPen. The generic product also has a copay discount coupon. Pharmacists can go to the epinephrine auto-injector website and find it there.

Visit for the full article in the upcoming January 2017 issue of Pharmacy Today.