Things like this just pop up. I was signing a check for supplies when I noticed a check over $840 from a local pharmacy. It was for a 2-pack of 0.15 mg epipens and a 2-pack of 0.3 mg epipens. You can't get them any other way. I looked at other pharmacies, and the $400 ones I had were $150 cheaper than the other companies. Henryschein, who we have an account with, charges $730 per package.
So, I have a couple of questions about this. First, I should say we obviously keep them on hand for emergencies mainly given the fact we give tons of immunizations and have in the past given allergy shots (which I do not plan on doing anymore). One person with asthma nearly went into anaphylaxis, but at this point, only one person in over nine years came close and, it was that person. Another way of putting it is we have not used an Epipen before. This even though we are paying $800 or more each year.
Now, of course, it's like fire extinguishers and oxygen tanks, etc. You need them when you don't have them. I keep hearing things about the need for Epipens, but is there a law in each state? I don't know. I have also spoken to a pharmacist who states they are required to keep at least two of each strength since they give shots at the pharmacy.
Now, I do know you can buy ampules or vials of epinephrine and use them during an emergency. But, you do draw up the exact dosing or do you just have 0.3 mg and 0.15 mg on hand. The dosing for Epipens are strange because of the 33 to 66 pounds and 66 pounds and over, yet there seems to be no dosing for the 0 to 33 pounds, although allergists have told me to use the 0.15 mg on anyone under 66 pounds.
Certainly, there is a huge advantage price-wise to use ampules and just make sure everyone is trained or even draw them up ahead of time. The FP doctor I lease from has them in each room. I find that would be dangerous in a pediatric office.
Part of the issue is that no matter how much one trains, the chance of a mistake is much greater during a panicky situation if you must either draw then or even find and use the predrawn syringes. There is an actual case of a local hospital where an overdose was given from a crash cart with a very bad outcome.
Given that one can give one dose while waiting for paramedics and repeat it five minutes later, it is good to have the two packs.
Granted Epipens were invented so those with peanut allergies or bee sting allergies could always have Epinephrine available. But, in some places, they have replaced the ampules. Also, given that Epinephrine comes in two strengths and the dosing is different dependent on IV or SQ (I realize it wouldn't be IV, but it is locked in my brain), it can even be more risky.
I guess part of it is how liable are you and how careful do you want to be with having extra doses. And, how much are you willing to pay each year for medication you have less than 0.01% chance of needing. Maybe some pharmacies will replace the meds when they expire which is a bit over a year. So, here are the options I have come up with and wonder what others think or do.
1. Pay the $800 and keep two of the different strengths available.
2. Buy just a two pack of the 0.15 mg. You now have Two doses you can give of the 0.15 and one dose of the 0.3 mg.
3. Go strictly with the ampules or vials.
4. Buy just a 0.15 mg two-pack and then have extra ampules which can be drawn up if more is needed. If you have someone trained they would have plenty of time to think clearly to draw them up. Or the doctor could draw it up, but he or she is usually needed for ALS, etc.
I am bringing this up now, since I need to make a decision on what is the right thing to do. It also depends on what the rules and regulations are, because if it is only having enough for one dose, then only having the 0.15 mgs makes sense.
Also, any experiences people have had with using epinephrine in the office and was it with Epipens or synringes.
