By Greg Friese
My son experienced anaphylaxis after multiple bee stings several years ago. I quickly learned how fast medication copays add up when we purchased multiple EpiPens to have at home and for him to keep at school.
The mainstream media has recently caught up with what EMS leaders, as well as parents of children with severe allergies like me, have known for a long time. EpiPens are expensive and the price has been steadily increasing for years.
Since price escalation, without a clear reason, has been a fact of EMS purchasing for several years, it seems EMS leaders have largely met the media and political umbrage with a yawn. Here are three things EMS leaders can contribute to the public discourse about epinephrine.
1. How often is anaphylaxis assessed and treated?
EMS systems demonstrate value to their communities by reporting response types and outcomes. Increasingly, annual reports detail sudden cardiac arrest incidence and survival in a community.
Anaphylaxis has a tight set of symptoms and specific set of treatment actions. EMS leaders should deliver a one-page report to local media and elected officials with these details for their response area:
- Number of calls for known or suspected anaphylaxis.
- Time intervals for activation, response and treatment initiated.
- Percentage of calls where patient care documentation supported an anaphylaxis diagnosis.
- Number of doses of epinephrine, by route, administered for anaphylaxis.
- Range of outcomes — symptoms resolved, worsened or no improvement — for patients treated for anaphylaxis.
A portion of the cost increase for EpiPens is driven by an increased demand through advocacy and legislation for public access epinephrine to be stocked in schools, buses, police cars, day cares and other community buildings. Proof that your EMS is agency is great at recognizing and treating anaphylaxis might counter some of the outcry for ubiquitously distributed epinephrine.
2. Why is EMS using alternatives to the EpiPen?
“Because it’s cheap” shouldn’t be the first and only explanation for implementing an alternative administration route. Auto-injectors are outstanding for medication delivery because they are easy to store, easy to use and require minimal training. Those factors though also come at a price. Mylan, the EpiPen manufacturer, is responsible for building a product that has the reliability of a commercial aircraft engine, can be distributed through a multi-stage supply chain and needs to be operated by a layperson with no training in delivering medications. Like many goods or services we usually only get to pick two out of three — cheap, fast or good.
Paramedics have long administered epinephrine from a vial or ampoule to patients experiencing anaphylaxis. EMS agencies and wilderness medicine providers have also taught the skill of drawing up and administering epinephrine to BLS providers for decades.
Though EpiPen alternatives are not new, the use or trialing of different tactics has been news for EMS agencies from Washington to Illinois to New York. Unfortunately the dominant theme reported in that news is the alternative to EpiPens has been selected because it is cheaper.
Reducing cost of services, especially health care, is always a compelling argument. But without supporting evidence that epinephrine administration can be performed just as competently as an auto-injector there is likely to be skepticism.
Imagine two different school nurse’s offices: one stocked with a neatly-packaged, easy-to-use EpiPen, and the other a collection of generic medical supplies stuffed into a plastic box purchased at an office supply store. As a parent, the decision is easy. I want my son’s teachers, camp counselors and our city’s police officers to have access to EpiPens or a commercially produced, FDA approved alternative.
3. What is your purchasing power?
EMS purchasing is likely a small slice of EpiPen revenue. It is not an accident that Mylan, the EpiPen manufacturer, has focused its marketing expenditures on mom-supported advocacy groups and elected representatives.
A small EMS agency may only need to purchase two to 10 EpiPens every two years. Their purchase and proportional influence on pricing is a fraction of a percent of total sales. Larger departments or agencies working together through bulk or group purchasing programs are more likely to have leverage on product price. EMS purchasing is particularly well suited for the generic, half-price EpiPen.
Anaphylaxis is a life threatening emergency. Just like cardiac arrest saves EMS leaders should draw attention to their successes with media outreach and survivor celebrations. What are other ways EMS leaders can positively add to the mainstream media conversation and political investigations to lower costs and improve patient care?
