Tag: drug coupons

Options During the Epinephrine Shortage

Of the medicines that you would hope that we would never run out of, epinephrine is probably on the top of the list for many people.

Unfortunately, many parents are still stuck dealing with shortages and delays of epinephrine injectors.

Why?

“The purpose of this letter is to inform you that in a very small number of cases, some EpiPen® 0.3 mg and EpiPen Jr® 0.15 mg Auto-Injectors, and their authorized generic versions, may not easily slide out of their carrier tube, which could delay or potentially prevent use of the device during an emergency.”

Dear Healthcare Provider Letter for Potential Label Defect of EpiPen Auto-Injectors and its Authorized Generic

For EpiPens, there was a problem with the labels on the injectors so that “in a very small number of cases, labels were not fully adhered to the surface of the auto-injector such that the device label may become stuck to the inside of the carrier tube.”

And for the Adrenaclick generic injectors, “Some lots of Epinephrine Injection auto-injector have passed all levels of inspection and met product specifications at the manufacturing facility, but have been found to contain particles upon further inspection.”

So both are now suffering from manufacturing delays after fixing these issues.

Luckily, most still have options for their kids with severe allergies.

Options During the Epinephrine Shortage

Can’t get your child’s prescription for epinephrine filled?

“Currently, EpiPen, EpiPen Jr and Adrenaclick remain in either a spot shortage or constrained supply.”

Alert – Epinephrine Shortage Update September 17, 2019

One of the first things to keep in mind is that the FDA has allowed for temporary extensions of expiration dates:

So check the NDC number and the original expiration date and see if you even need a refill yet.

The FDA has allowed for temporary extensions of expiration dates for some epinephrine injectors.

Next, know that many more versions of epinephrine are available than ever before!

If you can’t refill your child’s prescription because your pharmacy doesn’t have it, you might ask them which form of epinephrine they do have in stock, and then ask your pediatrician if you can use that version.

There are now six forms of epinephrine injectors available (with three that may be hard to find), including:

  • EpiPen, EpiPen Jr coupon – the auto-injector with the notorious reputation for the $670 retail price tag
  • Epinephrine injection (EpiPen, EpiPen Jr authorized generics) – coupon
  • Epineprhine injection (EpiPen, EpiPen Jr Teva manufactured generics) – coupon
  • Adrenaclick Adult, Child authorized genericcoupon – this is the epinephrine auto-injector that is available for $109.99 at CVS
  • SYMJEPI 0.3mg, 0.15mg – coupon – a new epinephrine pre-filled, ready-to-use device – not an auto-injector!
  • Auvi-Q – financial support – the epinephrine auto-injector that talks to you and has the notorious reputation for the $5,000 retail price tag

Whichever version you get, if you have commercial insurance without a high deductible, the coupon will likely cover your copay.

There are now six versions of epinephrine injectors available for children and adults with severe allergic reactions.
Can your pharmacy get you the Teva manufactured generic EpiPen or EpiPen, Jr?

And in a worst case scenario, if necessary, use an expired epinephrine injector, even if it is out of range of an extension, and seek immediate medical attention.

“If an in-date auto-injector is not available, it is better to use an expired auto-injector than to not give epinephrine.

Expired Epinephrine Can Still Save Lives

Still confused?

Hopefully you won’t be when you need to use your child’s epinephrine injector!

One very big issue with so many different types of epinephrine injectors is that their instructions for use are a little different.

“There are several different epinephrine auto-injectors available – Mylan EpiPen and Mylan Generic, Auvi-Q, and Adrenaclick; these auto-injectors have different steps for use.”

How to Use an Epinephrine Auto-Injector

We can also hope that once the shortages are resolved, a little competition will bring down the prices of all of these drugs, as even the generic EpiPens are at least $300!

More on Options During the Epinephrine Shortage

ADHD Medication List

Remember when we only had Ritalin, Adderall, and Dexedrine to treat kids with ADHD?

Know how many medications there are now?

Are All of the ADHD Medications Very Different?

Although there are a lot of different ADHD medications to choose from now, including some non-stimulants, it is important to realize that most of the stimulants are basically just different formulations or derivatives of Ritalin, Adderall and Dexedrine.

In fact, in many cases, it isn’t the ingredient that is different, but rather the delivery system.

Are your kids taking a short acting stimulant, that only lasts four or five hours? Or are they taking an extended release ADHD medication, that might last 8 to 16 hours? And if taking an extended release stimulant, are they simply taking one that mimics taking a short acting drug twice a day, releasing half of the medication immediately and another half 5 to 6 hours later? Or is it some other percentage on a longer, extended time release throughout the day, like the OROS time release system of brand name Concerta.

  • Adderall – mixed amphetamine salts – immediate release – lasts 4-6 hours – 5 to 30mg tablets
  • Adderall XR – mixed amphetamine salts – extended release with a 50/50 time release schedule – lasts 8-12 hours – 5 to 30mg capsules
  • ADHDnsia XR – methylphenidate – extended release
  • Adzenys ER – amphetamine – extended release liquid
  • Adzenys XR-ODT – amphetamine – extended release orally disintegrated tablets
  • Aptensio XR – extended release with a 40/60 time release schedule
  • Concerta – methylphenidate – extended release with a 22/78 time release schedule (OROS)
  • Cotempla XR-ODT – methylphenidate – extended release with a 30/70 time release schedule
  • Daytrana – methylphenidate patch – extended release
  • Dexedrine – dextroamphetamine – immediate release
  • Dyanavel XR – amphetamine – extended release
  • Evekeo – amphetamine – immediate release
  • Focalin – dexmethylphenidate – immediate release
  • Focalin XR – dexmethylphenidate – extended release with a 50/50 time release schedule (SODAS)
  • Jornay PM – methylphenidate – extended release
  • Metadate CD – methylphenidate – extended release with a 30/70 time release schedule
  • Metadate ER – methylphenidate – extended release with a 50/50 time release schedule
  • Methylin – methylphenidate – immediate release
  • Methylin ER – methylphenidate – extended release
  • Methylphenidate ER – methylphenidate – extended release
  • Mydayis – amphetamine salt combo – extended release
  • Quillichew ER – methylphenidate – extended release with a 30/70 time release schedule
  • Quillivant XR – methylphenidate – extended release with a 20/80 time release schedule
  • Vyvanse – lisdexamfetamine – extended release with a 50/50 time release schedule
  • Ritalin – methylphenidate – immediate release
  • Ritalin LA – methylphenidate – extended release with a 50/50 time release schedule (SODAS)
  • Ritalin SR – methylphenidate – extended release
  • Zenzedi – dextroamphetamine – immediate release

Do we really have over 25 different ADHD stimulants to choose from now?

Distinctions Without a Difference

Well, kind of.

For one thing, our choices of ADHD drugs to prescribe become much more limited once you realize how expensive these new medications can be, even if you try and use a drug coupon.

Price is a big difference on this ADHD medication list.
Price is a big difference on this ADHD medication list.

And again, our choices aren’t as big once you realize that most are really just different formulations or derivatives of Ritalin, Adderall and Dexedrine.

Can’t afford a newer ADHD medication for your child? Understand that many of these newer medications don’t actually offer all of that much benefit over older, less expensive medications.

Do you really need a liquid, chewable or ODT medication when most ADHD extended release capsules can be opened and sprinkled on food?

More on ADHD Medication List