With the arrival of new epinephrine auto-injectors to South Central Wyoming Emergency Medical Service (SCWEMS) we can all breathe a little easier. Literally and figuratively—the drug is used in emergency situations to treat anaphylactic shock, which can close a patient’s airways.
Upwardly spiraling prices and restrictive state regulations had left SCWEMS ambulance director Heidi Sifford scrambling to find an affordable replacement for the service’s “EpiPens,” or epinephrine auto-injectors. The service’s supplies were set to expire on April 1, but, at $680 per unit, SCWEMS couldn’t afford replacements.
Luckily, at the last moment, Sifford found a generic auto-injector costing $430 per unit and restocked the service’s seven ambulances for the next year. But it was a close call—and a wake-up call for the state’s regulatory agency, the Office of Emergency Medical Services and Trauma.
“We are one of the best-off volunteer services in Wyoming,” Sifford said. Even with their relatively good finances, however, SCWEMS nearly couldn’t afford a restock of the price volatile emergency medicine. A less-robustly funded service may not have been so fortunate.
There are cheaper alternatives to the auto-injectors. Syringes pre-filled with a single dose of epinephrine are less expensive, and purchasing the drug in bulk and allowing medical personnel to fill their own syringes is cheaper still.
According to Andy Gienapp, Administrator for Wyoming’s Emergency Health Service, these cheaper delivery methods require more training to use safely. Auto-injectors are “a way to deliver the medication with as little chance for error as possible,” Gienapp said. The other methods of delivering epinephrine carry more of a risk of overdose and require more expertise, Gienapp explained.
These problems are not insurmountable. According to a database compiled by the American Latex Allergy Association (ALAA), Oregon and Wisconsin both permit emergency medical technicians (EMTs) of all training levels to administer epinephrine with pre-filled syringes or with syringes the EMTs have loaded themselves.
That is not the case in Wyoming. Wyoming has five different ranks of emergency medical personnel: emergency medical responders (EMRs), emergency medical technicians (EMTs), advanced emergency medical technicians (AEMTs), intermediate emergency medical technicians (IEMTs) and paramedics. Only the most trained AEMTs, IEMTs and paramedics are allowed to use pre-filled syringes or to load their own syringes with epinephrine in Wyoming.
Of potentially making a rule change, Gienapp said that there is nothing immediately in the works. “It’s just about making sure we do it in the right way,” Gienapp noted. Though there would likely be savings from supplies, the state would also have to figure out how to effectively train their responders in the use of the cheaper but more technically demanding delivery methods. “You cannot just hand an EMT a syringe and a vial of epinephrine,” without training them to use them, he said.
Gienapp sounded sympathetic to the difficult position cash-strapped services have found themselves in as EpiPen prices have climbed. “As the demand for these things has gone up, the cost has gone up, too,” Gienapp said.
“The position in which Heidi [Sifford] found herself is that it costs this much to buy these things and we don’t use them very often,” Gienapp said.
For now, the problem is past. The question remains though: how much will EpiPen prices have risen by next March, when the current supply will expire?
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