Dr. Cathleen London runs a family practice in Washington County, where nearly 20 percent of residents lack health insurance, the highest uninsured rate in the state. So when the price for a life-saving allergy medication skyrocketed last summer, she knew there was no way her patients who rely on the drug could afford it.
The Epipen, an injectable dose of epinephrine, was ringing up at more than $600 for a pack of two. That’s much too steep for many a Down East fisherman — or many of us, for that matter — to afford.
People with dangerous reactions to bees, peanuts and other allergens rely on Epipens to keep breathing long enough to get to a hospital. The medication works in an emergency by temporarily thwarting the severe allergic reaction known as anaphylaxis.
London was disgusted that Mylan, the drug’s maker, was driving up prices. But she refused to let her patients go without.
Instead, she started inspecting the insulin pens she stocked at her Milbridge office, which patients can use to inject themselves with a pre-measured dose of medication, similar to the workings of EpiPen’s “auto-injector.” A few Google searches later, and she’d devised her own version of the EpiPen using the insulin pen, which she fills herself with epinephrine.
No patients have needed refills yet, but London can provide one as her patients administer the reusable injectors or the medication expires. Epipens, on the other hand, can’t be reused, so when the epinephrine they contain expires, patients must toss out the perfectly good auto-injector along with it.
London charges her patients $50 for the device, and $2.50 for a refill.
London recognizes that her DIY solution isn’t the answer to exorbitant drug prices. Replicating it on a larger scale would require the involvement of the U.S. Food and Drug Administration, for starters, which has separately approved the insulin pen and epinephrine, but not in the combination London devised.
Still, there’s no reason why other physicians couldn’t use her idea, she told me by phone on Wednesday.
“Any doctor could do this easily,” said London, a Yale-educated physician and triathlete who left a teaching gig at Cornell to move to Maine in hopes of treating an underserved population and living on the ocean.
(“I love it, I couldn’t be happier,” she said.)
Some have raised liability concerns about London’s device, suggesting a patient could sue her if it fails to work properly and that sterility could be jeopardized since she fills it herself. She bats those worries away, saying she’s not marketing the device for use outside her practice. Even if a patient developed a localized infection as a result of the device, that’s a small risk compared to lacking an epinephrine injector in an emergency due to the cost, London said.
She plans to keep offering the auto-injectors to her patients, but London doesn’t want to see Mylan let off the hook.
“At some point we pressure Epipen to stop their nonsense,” she said.