Tag Archives: epipen

Mylan expands EpiPen cost-cutting programs after charges of price gouging

From CNBC, Mylan is reducing the cost of EpiPens through the use of a savings card that will cover up to $300 for the EpiPen 2-Pak.

Patients who were previously paying the full price for the EpiPen will have their out-of-pocket cost cut by 50 percent. Mylan also is doubling the eligibility for its patient assistance program, which will eliminate out-of-pocket costs for uninsured and under-insured patients and families, as well.

Read the article here and the official press release here.



Can You Get a Cheaper EpiPen?

You could save about $400 per two-pack with generic Adrenaclick and still protect against life-threatening allergy attacks.

Source Consumer Reports: Can You Get a Cheaper EpiPen? – Consumer Reports

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2014 Allergy Year in Review

Untitled-3The new year has arrived and it’s often a time to reflect on trends and highlights from the previous year. Below is my list of the highlights in the world of allergy in 2014. Enjoy and may you have a healthy and happy 2015!

  1. Allergy Partners of Louisville Opens: On January 2, 2014, I opened my own solo allergy practice with a wonderful staff and team. The office moved to its permanent location next to Wild Eggs in the Landis Lakes Shopping Center in June. The new office is even more patient-friendly with large HD monitors in every exam room with multiple viewing options, fewer “pokes” with allergy testing and shorter conventional allergy shot build-up schedules without having to pre-medicate with steroids.
  2. Nasal steroids moved to become available over-the-counter (OTC): Nasacort was approved for the switch from prescription to OTC and became available as such in February 2014. Steroid nasal sprays are considered first line treatment for moderate to severe allergic rhinitis. Look for others to follow suit in 2015. Flonase is expected to be on retail shelves in early 2015.
  3. Asthma inhalers continue to shift toward emphasizing smaller particle sizes: Aerospan became available in the US after Meda Pharmaceuticals bought Acton in late 2013. Better, deeper lung deposition is thought to be the benefit of inhalers with smaller particle size. Look for specialists to increase their use of Aerospan, Alvesco and Qvar, the three inhalers with the smallest particle sizes in 2015.
  4. FDA-approved sublingual immunotherapy (SLIT) becomes available in the US: Look for the products Grastek, Ragwitek and Oralair to be marketed heavily in 2015 and directly to consumers. You too have probably seen Grastek’s countdown to grass season whole page ads  in the Courier-Journal and other publications. The main benefit is home administration. Barriers include cost, potential side effects, need for an injectable epinephrine device and the requirements of receiving the 1st dose in the physician’s office. Better discount programs should improve usage in 2015.
  5. The end of Maxair: Under the Montreal Protocol, all CFC-containing, ozone-depleting inhalers were phased out by the FDA as of December 31, 2013. Maxair could not be made or sold after December 31, 2013. This means any Maxair still in your drawers or purses should be properly disposed of, as they are expired and no longer compliant. If you’re still carrying Maxair or the old CFC version of Combivent, see your doctor to discuss alternatives. If you are still carrying an old white generic albuterol inhaler made by Wallace or Warrick, you may need to go through your medications more often!
  6. Xolair receives indication for Chronic Idiopathic Urticaria (CIU): Omalizumab or Xolair is a biologic antibody that has been available since 2003 for the treatment of allergic asthma. Xolair was approved for CIU in 2014 and will provide another step in the treatment options for hives sufferers before having to consider medications with more significant side effect profiles.
  7. Affordable Care Act to further drive consumer awareness of the cost of health care: As my family compared health insurance options for 2015, the changes brought on by the ACA were noticeable. Look for premiums and deductibles to rise. Shorter build-up shot schedules and smaller test panels without sacrificing quality will position Allergy Partners of Louisville as one of the most cost-conscious allergy choices in the Louisville market.
  8. Component Food Allergy Testing: More and more allergists are using component resolved diagnostic testing to aid in clinical decision making for food allergy sufferers. Component food allergy testing uses allergy specific blood testing to look at the components of specific foods like peanut, egg and milk. Knowing if a patient is allergic to casein or ovomucoid in milk and egg, respectively, can help a family know if they will tolerate cooked milk and egg in products. Knowing a patient’s Ara h2 level for peanut allergy is much more precise in knowing whether a patient will tolerate an oral peanut challenge. Look for component resolved diagnostics to become standard of care in making decisions for reintroduction of known food allergens.

That summarizes my year-end reflections on the ever-changing world of allergy. Thanks to each of you for a rewarding 2014 and going with me on this amazing journey in relationships and providing better health to patients. Best wishes and God bless in the New Year!

Derek Damin, MD

Winter Allergy Tips

Untitled-1The winter season often brings different allergens and environmental triggers to the forefront compared to the blooming seasons. Greater time spent indoors means more exposure to dust mites and pet dander. Cold, dry air can be a trigger for respiratory and skin conditions. Here are some tips to help you during this time of year:

  • Dust mite covers for mattresses and pillows can reduce dust mite exposure.
  • Room air HEPA filters and regular pet washing can reduce pet dander and other airborne irritants.
  • Wash bedding in hot water once weekly to reduce dust mite exposure.
  • Although humidity greater than 50% can lead to more dust mite and mold growth, excessively low humidity in the winter can be problematic as well. Dry air leads to dry skin and dry skin means “itchy skin” which often leads to worsening eczema. Consider humidifying the air in the winter months. This can also improve nasal dryness and the propensity for winter nose bleeds. (Remember to keep that humidifier clean!)
  • Don’t leave inhalers or epinephrine injectors in the car where they can freeze. Freezing can reduce their effectiveness.
  • Any indoor particulate matter can increase asthma symptoms. Watch for common culprits including wood stoves and fireplaces. Dust is a common irritant when Christmas décor and winter clothing are brought out of storage for the season.
  • Remember to change your HVAC filters regularly.
  • Get a head start on Spring. Allergy shots often take several weeks to reach effective an effective dose. Now is the time to get started if last year’s pollen seasons were severe.

Be sure to subscribe to receive updates by email (scroll up and hit the “Follow” button on the right)? Please “like” my facebook page at www.facebook.com/drdamin, follow me on Twitter and share this page with other allergy sufferers.

Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.


First Grass Tablet, Oralair, Approved by the FDA

On Tuesday, April 1, 2014, the FDA approved Oralair, a grass tablet for sublingual use. Initial reports show it will be indicated for those ages 10-65 with seasonal allergic rhinitis with or without conjunctivitis and a confirmed positive skin test or blood test to any the following grasses: timothy, Kentucky bluegrass, perennial rye, orchard and sweet vernal. Oralair, once available, should be dosed once daily and held under the tongue until fully dissolved. Treatment should begin four months before grass season and continued until grass season ends. Additionally, the first dose should be administered in a physician’s office where the patient can be monitored for a period of time after administration. allergy tabletPatients should be prescribed injectable epinephrine and counseled on the signs and symptoms of an anaphylactic reaction. Clinical studies showed an improvement in symptoms between 16 and 30%. It is not without risk, as one-third of adults had oral itching with its use and 12% of kids had mouth swelling.

This is the first sublingual immunotherapy product to be approved by the FDA. There are other sublingual tablets in development including ones for dust mites, ragweed and an additional grass tablet.

It does not appear to be as effective as traditional allergy shots, but head to head studies are lacking. Cost and insurance coverage will definitely affect prescribing habits.

Call our office to get allergy tested and see if this new treatment is right for you. We’ve missed the window for the 2014 grass season in the Louisville area, but use will likey increase in subsequent seasons.

Be sure to subscribe to receive updates by email (scroll up and hit the “Follow” button on the right)? Please “like” my facebook page at www.facebook.com/drdamin, follow me on Twitter and share this page with other allergy sufferers.


Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community. If you need to establish care with an allergist, Allergy Partners of Louisville would love to help you find relief. Call 502-882-2063 for an appointment.

Alert for Epinephrine Autoinjector Prescriptions

epiIf you or your family have food allergies, stinging insect allergies or a history of anaphylaxis, pay close attention to your epinephrine prescription the next time it is refilled.

Just last week national allergy organizations sent announcements to providers to make them aware that a generic version of the Adrenaclick® auto injector is being marketed under the name epinephrine injection, USP auto-injector. Adrenaclick® was a 2.0 version of the Twinject® device without the second dose inside. The availability of this generic version of Adrenaclick® could result in substitutions of other autoinjectors at the pharmacy. This is not a generic version of the EpiPen® or Auvi-Q® devices. It is important for patients and caregivers to receive the injectable epinephrine device on which they have been trained to minimize confusion, which could lead to a delay or an error in administering the drug.

Before leaving the pharmacy, make sure you have received the appropriate device. Further information and instructions for administration can be found at the following websites:

Be sure to subscribe to receive updates by email (scroll up and hit the “Follow” button on the right)? Please “like” my facebook page at www.facebook.com/drdamin, follow me on Twitter and share this page with other allergy sufferers.

Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.

Using Expired Medications

expired med

Ever been in this situation? You have a cold and when you look in your medicine cabinet, you discover your cold medicine expired three years ago. Do you take it or throw it out? Let’s talk about expired medications, their safety and which ones should not be kept past their expiration dates.

I find patients with old white rescue inhalers in their purses. What’s the big deal? The white ones are the generic albuterol inhalers made prior to 2008 before the CFC propellants were taken off the market for ozone concerns. That’s some old (and likely ineffective) albuterol!

For physicians wanting unbiased, reliable and timely drug prescribing information, The Medical Letter is a valuable publication published by a nonprofit organization. It has helped me optimize my prescribing behavior with cost and effectiveness in mind.  For example, a past article explained that the surface of the eye can barely hold one drop of liquid medicine and anything extra just runs down your face. I no longer prescribe “1-2 drops in each eye” because I know the second drop is wasted.

A December 2009 article in The Medical Letter titled Drugs Past Their Expiration Date examined safety and effectiveness, citing data from the Department of Defense/FDA Shelf Life Extension Program. The purpose of the program was to save money on military stockpiles of medications if they could be used safely and effectively well past their expiration dates. They found that 88% of over 3,000 lots of 122 different drug products remained stable for an average of 66 months past their original expiration date if they were unopened and in their original containers.  The article also stated there were no reports of human toxicity from current drug formulations used after their expiration date.  A longer usable lifespan is therefore suggested, at least when it comes to tablets or dry, powder medications.

This is not generally the case with liquids. While all medicines are more likely to degrade with extremes of temperature or humidity, solutions and suspensions (liquids) are usually more susceptible to this degradation.  Dr. Estelle Simons, a well-known allergist, did a study on out of date EpiPens and showed a significant decrease in epinephrine content with greater time past the expiration date.  There is no room for error when it comes to Epipens. They are needed in cases of life threatening anaphylaxis. Delayed administration and under-dosing have been associated with increased risk of dying. It is imperative to keep your EpiPen up to date. Since most rescue asthma inhalers are “aqueous,” they too should be kept up to date.

So in summary, drug companies and doctors are limited by liability and legal restrictions when it comes to following the expiration dates of medications. It is always best practice to keep medications in date. However, data exists to suggest dry tablet or powder forms of medications might have a longer shelf life. That is not the case with liquids. You should always renew your water based rescue inhalers and EpiPens once their expiration date is reached.

It’s time to clean out your medicine cabinet. (Click here to learn more about safely disposing drugs in the Louisville-area.) It may feel as if you just bought that bottle of Nyquil, but there’s a good chance it expired 2 years ago!

Be sure to “like” my facebook page at www.facebook.com/drdamin and share this page with other allergy sufferers.                 

Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.