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Comment by pg_bot | Hacker News Reader

While there are other epinephrine auto-injectors on the market (auvi-q and adrenaclick) the big difference here is that this is considered a "generic" version of the EpiPen. The significance is that pharmacists can recommend that a prescription for an EpiPen be replaced with this, where they cannot with the others on the market. I will also note that the cost of the EpiPen is not due to the drug, it is the patent on the auto-injector which is set to expire in 2025. If you wanted to actually improve this product, you would follow the SpaceX model and allow replaceable cartridges for the auto-injector instead of throwing away the entire housing when the medicine expires every 18 months.

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I agree with your bit about prescriptions. However I don't think following "the SpaceX model" would be very useful (or even a good idea) here. A few reasons: 1) the housing and needle are dirt cheap to manufacture, and as you said, it's the patent that is expensive and replaceable cartridges wouldn't get around that 2) much of the safety of these things is the clear labeling around expiration and such 3) the risk of improperly replacing a cartridge far outweighs the benefit of reusing a bit of plastic 4) you could only replace un-used epi-pens, as replacing the needle sounds dangerous

> allow replaceable cartridges for the auto-injector

I think the risk of reusing injection equipment is chance of infection. Also a more reasonable solution to the wastage is to do a long term study to extend the expiry date. The drug manufacturer don't do a long study because of the lost time plus potential extra sales.

I am still for single use, but if it is unused and the medicine expires people throw away the entire thing. The reason for replacement every 18 months is that the medicine expires, if you could just replace the medicine if you didn't use it you may see cost savings. However, I am just spitballing here and it is likely that there are reasons why this cannot come to fruition which I have not considered thoroughly.

Most of the cost is just the patent exclusivity plus paying for R&D/testing. If someone invents a new mechanism it will have to start over again and will stay expensive for another decade or two.

The simpler thing is do enough testing to extend the life of the current solution to 3-5 years. The manufacturer will have no incentive to do that unless there is some competition.

https://www.npr.org/sections/health-shots/2017/07/18/5372578...

As far as that goes, we have a long line of safety for this. Many other approved injections for home use have replaceable cartridges. These cartridges often include the pre-measured dose along with a sterile, new needle.

> and allow replaceable cartridges for the auto-injector

A good idea, but also possibly a point of failure (by the end user) in an emergency. Epipens come in pairs for these rare, but possible, occurrences.

The anaphylaxis action plans we've received have all called for a second injection shortly after the first if no improvement is observed. I suppose that could be because most people will have 2 injectors on hand and docs know it.

>I will also note that the cost of the EpiPen is not due to the drug.

Spot-on. I remember when I was doing my anesthesiology residency and I asked the guy who ordered drugs for our department what a 1cc vial or ampoule of epinephrine (an auto-injector delivers precisely that amount) costs; he replied (this was the late 1970s, mind you), "About 10 cents." Even allowing for inflation, I can't imagine it's more than $1/dose today.

Looks like king county is getting them for $9/dose:

https://www.jems.com/articles/print/volume-42/issue-6/featur...

I talked with a Pharmacist a few months ago about the cost of epinepherine, and a 10 dose bottle was $6.

I must say I'm surprised this drug is available in a multidose bottle because of the potential for contamination. I've only ever seen it — in many hospitals large and small, in both California and Virginia, over the past 40 years — in 1cc bottles and ampoules. That is and has long been the default adult SQ and IM dose. In STAT situations it's given IV or, as a last ditch measure attempting to reverse cardiac arrest, via direct intracardiac injection using a long needle.

Or we could reform patent laws. Asthma inhalers are currently egregiously expensive because a change in law prohibited out-of-patent inhalers over the tiny amount of CFCs they contained.

Yes, the EpiPen was first marketed in 1987. It would be quite interesting to see an evaluation of all the patented improvements that have been used to keep alternatives off the market.

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