By Henry Ehrlich
A month ago we greeted the approval of TEVA’s entry into the epinephrine injector market with cautious enthusiasm. But we also questioned whether the new competition for EpiPen and Auvi-Q (and Adrenaclick, the perpetual afterthought) would be sufficient to drive down prices. Then we came across an article that posited it takes at least three competitors to take a meaningful bite out of the price tag. Thus we can welcome FDA approval of a low-dose version of Symjepi, which rounds out their product line—a high-dose version had already received a government okay, although we missed that. That would make three, or so it would appear. Unfortunately, this one is a pre-filled syringe instead of an auto-injector and would require special training for use.
Regardless, the competitive effects these new injectors represent are entirely notional for now since they are nowhere near the market. A time of shortage is not conducive to a price war. EpiPen, for generations the dominant player, is suffering from manufacturing problems and in short supply.
For the long-term, assuming EpiPen finds its footing again, we must wonder how many competitors there will be and whether that be enough to pressure Mylan. Much as we love Auvi-Q it is not a generic and must compete on the basis of coolness, ease of use, vocal capability, and for now ample supplies. Adrenaclick, like EpiPen, is manufactured by Pfizer, and like it is suffering from manufacturing problems that have led to shortages. So can we count it as one of the three competitors?
Thoughts on Shortages
The shortages are creating some interesting accommodations. For example, Walgreens has started offering Auvi-Q, the first time it has been offered at a retail pharmacy, instead of by mail.
Also, EpiPen has relaxed its 12-month replacement policy with the blessing of the FDA, extending it to 16 months. They are in effect admitting that the stricter standard was bogus. If it remains in place, instead of buying 10 injectors over a decade, the consumer would buy only about eight. That will be a big blow to the bottom line.
And as a reminder, the list of Chinese imports subject to tariffs included epinephrine the last time we looked. If there were a sudden rush to build strategic epinephrine manufacturing facilities the cost to consumers would skyrocket.