EpiPen's share of prescriptions for life-saving allergy medications has dropped slightly since 2013, suggesting that some patients and providers might be reaching for alternative treatments.
Prescription data from more than 970 doctors on the athenahealth network — writing more than 78,000 prescriptions to more than 48,000 patients — shows that EpiPen prescriptions dropped from nearly 96 to 92 percent since August.
And though they make up only 5 percent of the market, prescriptions for alternative auto-injectors of epinephrine are up 26 percent this year over last. Right now, according to Jing Luo, M.D., an internist and researcher at Brigham and Women's Hospital and Harvard Medical School whose work focuses around prescription pricing and drug policies, that's represented by the only other available product on the market: Adrenaclick.
Mylan drew widespread criticism over the summer when news stories revealed that the company had hiked the price of the life-saving drug by 500 percent since 2009. Congress held hearings into why these pricing changes were warranted.
Still, with no generic versions of EpiPen and few comparable products on the market, the vast majority of physicians have not been prescribing alternatives. And since annual expiration dates require regular refills, EpiPen's growth has expanded every year.
The number of prescriptions written by providers for EpiPens across the athenahealth network has grown by 14 percent since last year. The data shows that EpiPen prescriptions spike during back-to-school season, when schools require that children with severe allergies bring auto-injectors of epinephrine to have on hand in case of emergencies.
"It's a branded product that commands a lion share of the market — in some ways it's the Kleenex for epinephrine auto-injectors. Secondarily it's essential medicine that is lifesaving for millions of people, so the need to have that is great irrespective of cost," says Luo. "[EpiPen] saturates the market in such a way that many prescribers don't know that there are alternative products. If they have an EHR they are typing EpiPen into their system — and those systems may not even be pulling up the alternative."
It's not clear who is driving the apparent shift to EpiPen alternatives — patients demanding another option from their doctors, or physicians deliberately suggesting alternatives when they may have previously deferred to the name brand solution.
According to Luo, most practicing physicians don't talk too much about cost with patients.
"I think if you ask the average patient what their doctor says to them about drug costs they will say that almost never happens," says Luo. "That being said, because of all the negative coverage in the news, I wouldn't be surprised if the physician is asking if the price of the drug is an issue now. I'm willing to bet if you track awareness among physicians around cost of EpiPens the doctors are a little more cognizant of that and are much more likely talking about it with the patients in the office than they were."
Luo says the insurance provider and pricing structure for the payer might also be affecting a shift to EpiPen alternatives. Patients with high-deductibles and uninsured patients especially are likely to be more price aware during this fall when many patients are getting their auto-injectors of epinephrine refilled. "For branded products the formulary or the copay is a definite driver of patient behavior — people tend to fill the cheaper things on average."
But if Mylan succeeds in its current maneuver it's debatable whether or not consumer behavior will continue to have an impact on their profits, or if price hikes will dissipate. The U.S. Preventive Services Task Force is evaluating Mylan's application to have EpiPen added to the a federal list of preventive medical services, alongside wellness visits and drugs like birth control. If this occurs, the costs will shift from the consumer's wallets to the government and insurance companies, and likely, out of the spotlight.
Data analysis by Anna Zink, based on prescriptions written to over 48,000 patients by more than 1,100 doctors who have prescribed EpiPen on the athenahealth network since 2013.