I’ve been challenged on the idea of whether or not Mylan is a monopoly, if so, what caused it, and how many competing solutions could exist in this relatively small market. I claim they are not, because alternatives exist. Other say they are a monopoly because there is not a generic EpiPen(r).
I’ve been told Europe has thriving competition in the autoinjector market and supports EIGHT different solutions. I’ll get back to this point later, but I did uncover two important developments in Europe that we aren’t seeing here in the US.
- The newer models are being offered in an additional dose of 0.5 in addition to 0.3 and 0.15. The new dose supports a higher body weight patient.
- There have been research results on needle length and one of the newer injectors addresses these new findings.
I have no idea about the state of regulation over there, but here are the claimed EIGHT other autoinjectors I found on the internet:
– seems only available in Poland – It is a Pre-Filled Syringe, not an autoinjector – I found the 0.3 pre-measured device, so I assume they also support 0.15. The price online is 55.64 Polish Zloty equals 14.22 US Dollars. It also has a 50% rebate; not sure what is required to qualify for it. This is the physically smallest option I assume it comes in a carrying case.
– Offered in Spain – It is a rebranded EpiPen (based on photos in the patient pamphlet). Introduced late 2012.
“Adrenaline (epinephrine) 1 in 1000 solution for injection BP auto-injector”
– available UK – generic looking auto-injector. The user must replace cap to shield the needle after use. The device is white and the removable needle end cap is red. Unable to find additional information. Unable to estimate the size of the device, but it looks a bit longer than an EpiPen.
– UK – This one requires pushing a trigger on the outer end of the device, which is contrary to instructions for other devices that say never put your thumb over either end for fear of holding the thing backward. Also, the trigger on the end is red, which is the same color as the needle end of EpiPen. This could cause further confusion. It is unclear if you push the trigger early will it will fire into the air? The needle remains exposed and requires replacing the end cap for safety. 24-month shelf life. Supports the new 0.5 dose. Diameter looks similar to old EpiPen, but about 1 inch longer. I did see one reference that the needle is actually shorter than EpiPen and recent research indicates that a longer needle (25mm) is actually appropriate for adults.
– made is Sweden – “a Prescription only Medicine and is available in Sweden, the Netherlands, the UK, Ireland and Germany.” The website indicates many other countries are in the process of approving the device. It has a 25mm needle for the adult doses (EpiPen has 16mm needle length) The longer needle is to address the needs of adults who may have a greater sub-c fat layer and is recommended for all adults. It has a self-sheathing needle and 30-month expiration with no upper-temperature limit. Available in the 0.5 dose. Looks about 1 inch longer than new EpiPen and similar in diameter. Sold for 400 Swedish Krona equals 46.66 US Dollars.
– is a rebranded EpiPen. Information is primarily in German and/or Italian.
– Greece, could not find any other details. Not even a picture.
– a newer design manufactured in Spain, sold in Austria, Belgium, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Luxembourg, The Netherlands, Norway, Slovakia, Spain, Sweden, United Kingdom. Look very similar to old EpiPen in size and operation but has a self-sheathing needle.
– Emergency medication does no good if you don’t have it with you, so anything to dissuade you from carrying is a detriment. I used to carry an Ana-Kit PFS that held two doses and when that was no longer available I had to carry EpiPen. I was further disappointed when EpiPen was redesigned to make it larger still with the needle guard. Imagine my surprise when I was prescribed the generic which is the same size as the original EpiPen. I can carry two generics in the space of one new EpiPen.
So let’s look at some size comparisons. This is not rigorous and is based on internet photos.
Jext is thinner than the new Epipen, but a little longer. AnaPen is longer still. I carry in my front pocket and anything longer than EpiPen would be uncomfortable in blue jeans. Work trousers would have a bit more room.
CAVEAT: I have no idea if this photo of Emerade is accurate in relative size. But the Emerade website is very careful to avoid size comparisons, so I suspect it is larger than the others. How much larger? I have no idea. Notice the photo below shows EpiPen and Jext out of their carrying case and Emerade doesn’t require a case.
I found evidence that EpiPen brand is sold in Europe in some countries. I could not however find Adrenaclick or the generic of that one.
So, in response to the claim there are Eight (plus Epipen) options in Europe I disagree. Of the Eight:
- One is not an autoinjector
- Two are rebranded EpiPen
- One cannot be found on the Internet
The other four are:
- Anapen – not user-friendly, too big, question on needle length. I would not carry.
- “Adrenaline (epinephrine) 1 in 1000 solution for injection BP auto-injector” – probably ok, but looks to be larger than would fit in my pocket
- Emerade – Appears to be the largest. 😦 Otherwise it is the most advanced.
- Jext – Of these four options or EpiPen I’d choose this one. Depending on how the size compares to generic Adrenaclick I might stick with what I carry now.
How about a Prefilled syringe (PFS)?
Just because I previously carried a PFS doesn’t mean I would want to go back to that. I wouldn’t want to self-admin that, nor would I want someone who was untrained or panicking to try to either.
Does Europe have more alternatives? Yes, but not as many as you think.
Are they all ‘good’ options? No, I don’t think so.
Are they more advanced than what’s in the US? Yes.
The question now is why? Is it because the US government is stifling competition and innovation with too many regulations? Or is it because the capitalist model for running your healthcare system puts profits above improving people’s lives?
What are your thoughts?