Ann Arbor, MI—In 2016, controversy raged over the high price of epinephrine autoinjectors.

That issue was resolved over the years, with most severe allergy patients paying less for their lifesaving equipment than they did when the EpiPen was the primary option.

Th researchers from Michigan Medicine and Boston University advised, however, that some patients still face very high costs for epinephrine autoinjectors because of their health insurance plans.

"Our findings suggest that the availability of lower-priced competitors did not solve the affordability problem for all patients who use epinephrine auto-injectors, particularly those covered by plans that require deductible and co-insurance payments for drugs," stated lead author Kao-Ping Chua, MD, PhD, a pediatrician at the University of Michigan health system. Dr. Chua and co-author Rena Conti, PhD, from Questrom Boston University School of Business, recently published their results in the Journal of General Internal Medicine.

The authors analyzed 2015 to 2019 data from 657,813 children and adults using the IBM MarketScan Commercial Database, a national claims database including information on 28 million Americans with private employer–sponsored insurance. During that period, they found that the branded EpiPen faced increasing competition from its own lower priced authorized generic, Adrenaclick, and a generic autoinjector manufactured by Teva.

Their report reveals that mean annual out-of-pocket spending for epinephrine autoinjectors peaked in 2016 at $116 and began to decrease in 2017, with patients moving more toward lower priced competitors to EpiPen. By 2019, the mean annual out-of-pocket spending had fallen to $76, with 60% of patients paying $20 or less for epinephrine autoinjectors.

Yet, one in 13 patients still paid more than $200 for epinephrine autoinjectors in 2019. Most of those patients (62.5%) were enrolled in high-deductible health plans, which cover approximately 30% of privately insured Americans in 2019 and had a minimum deductible of $1,350 for individuals and $2,700 for families.

In fact, the study advised that more than half (63.3%) of the patients paying more than $200 per year were children. Dr. Chua suggested this might be because children need to fill prescriptions more often than adults so that they can have epinephrine autoinjectors for both home and school.

Yet, nearly two-thirds of patients paying more than $200 per year only used lower-priced nonbranded products, such as the authorized generics of EpiPen and Adrenaclick. Their mean annual out-of-pocket spending was over $650, and 88% of that cost was related to deductible and coinsurance payments.

"Our study shows patients can still pay a lot even if they use lower-priced epinephrine auto-injectors. To improve affordability for these patients, insurers could consider capping the out-of-pocket cost of non-branded auto-injectors. Alternatively, the federal government could consider a federal cap similar to the one currently being discussed for insulin," Dr. Chua said.

The same study team did an analysis in 2017 showing how much privately insured Americans paid yearly for the branded EpiPen between 2007 and 2014. EpiPen then dominated the epinephrine autoinjector market with little competition, and the authors found that out-of-pocket spending for the EpiPen doubled, largely because its list price tripled.

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