Wednesday, February 15, 2017

Epinephrine Epipen - What is the Cost?

Ever had a life-threatening allergic reaction that would be treated immediately with an Epipen of epinephrine? I did recently on a Friday near the Noon hour when I received two wasp stings to the crook of my right arm. I didn't see it coming, but felt the intense burning sensation from the stings and saw the tiny welts forming at the sting locations along with blood.

Polistes carolina rust-colored wasp
Polistes carolina rust-colored wasp
The type of wasp that stung me!
It is a scary feeling when you experience your first severe allergic reaction. Soon after the stings, the palms of both my hands began to itch ... and I was scratching them until I saw they were bright red. Soon afterwards, I felt my tongue begin to swell and felt my lips begin to swell, much like they were being pumped up like with a bicycle air pump. Very crazy sensations. I remember running my tongue across my top lips from the right side, feeling like I would have a couple of large fever blisters. That's the location where I usually get those fever blisters. I also could tell my right ear was affected as I couldn't hear out of it. Coming inside, I could see in the mirror that my face was extremely red and blotchy. My right ear was the deepest red color and hot.

So many thoughts ran through my mind. What should I do? I took a Benadryl-equivalent CVS allergy pill. Then, I showered since I had been very sweaty and dirty from sweeping the leaves in my street for about an hour before the two wasp stings.

Getting out of the shower, I phoned my doctor's office. It was near 1pm on that Friday afternoon. I didn't reach my primary care physician, but instead got the answering service. That gal seemed annoyed. I think I said, "Oh, this is the answering service? I needed my doctor. Never mind, I'll probably need to go to the ER."

After hanging up from that call, I phoned my Publix pharmacy. I first got a tech and then was put on the line with the pharmacist. She also told me to go to the ER. I pulled my health insurance card to see what the ER copay charge is ... $75. The next thought that ran through my head, "oh my, how much is that going to cost me?" I had been hearing in the news that the Epipen drug company had been raising its price to $600 and more. I couldn't afford a thousand dollar ER visit or probably more. So, I opted to tough it out!

I took another Benadryl-equivalent CVS allergy pill and poured a Publix diet ginger ale. I could feel the most intense sensation of heart burn ... and needed to calm myself lest I have a heart attack. I grabbed three ice compresses from the freezer, putting one on my throat area, another on my right ear, and the third on my swelling right arm. I sat in the recliner with my feet up and started meditation like thoughts.

It was about 6pm when I started to feel like I might be not getting worse, but improving. It seemed my tongue, lips and right ear were going back to a sense of normalcy.

On Saturday, about 24 hours after the wasp stings, I drove to the Publix pharmacy and spoke with the pharmacist. She mentioned that she had spoken with me on the telephone the day before. Again, listening to me and looking at the swelling of my right arm, she told me I needed to go to the ER. "OK, I'll go!" I replied.

I drove a few miles to Florida Hospital Waterman ER. Speaking with the nurse at the desk, I told her, "I don't want to waste an ER visit if I don't need to." She looked at my right arm and listened to my allergic reaction experience. She said to add Zantac and warm compresses to my routine and come back if I got worse.

I stopped at Walgreen's and picked up a Zantac-equivalent and a hot-cold compress. Once home, I added the Zantac-equivalent to my Benadryl-equivalent and heated up the compress. The warm compress was a bit of a blessing -- it felt so good on my inflamed and swollen arm.

Monday couldn't come around soon enough!! First thing in the morning, I telephoned my doctor's office and got an appointment within the following hour. The nurse looked at my red inflamed, swollen right arm and said that I still had a case of Cellulitis going on. "Cellulitis appears as a swollen, red area of skin that feels hot and tender." The doctor noted that my blood pressure was too high. She wrote me a prescription for 3 days of Prednisone twice a day. We also talked about getting an Epipen, but I didn't ask her to write me that prescription because we discussed how expensive that is.

For about one week's time, I took it easy and didn't do my usual exercise workouts. And, then I started to research the cost of an Epipen!

On February 8, 2017 at 5:54pm I wrote an inquiry to my medicare-advantage health care provider.
Last Friday, I had a life-threatening allergic reaction to two wasp stings. It was the first time ever that I had such a strong allergic reaction with swelling to my lips, tongue and ear. I was lucky in that I quickly took two Benadryl tablets and iced the swelling. I spoke with the Publix Pharmacist during the reaction since my doctor's office was closed for the weekend. They told me to go to the ER. I did stop by the Waterman Hospital ER 24 hours later where they said to add Zantac plus warm compresses and come back if I got worse. This past Monday I saw my doctor who discussed writing me a Rx for epinephrine Epipen. We discussed the great expense of this Rx. I chatted with my Publix pharmacy today to check that they had the generic Epipen. They do. I am wanting to know what would be my out-of-pocket copay for this. Thanks.
I received a reply to my inquiry on February 9th at 2:33pm:
I tried to check in our system the copayment for the medication you listed below, however when I entered "epinephrine Epipen" in our system I get either epinephrine or Epipen. To further assist I will need the exact name of the medication and also the quantity and milligrams. Please reply back and let us know.
February 11th at 5:11pm I responded:
Hello!! It is the generic EpiPen ... the pharmacist assistant wrote "EpiPen epinephrine" when I asked for the name! If you are showing more than one of the "generic" EpiPens, I would like to know what my out-of-pocket costs are for those two ... with the specifics on what they are. I would think the pens are standard for dosages.
February 13th at 9:22am I responded with more information since I hadn't gotten a response to my initial question:
I have been googling "publix epinephrine" and found two references to the epipens offered at Publix and other pharmacies. Please see these pages:

Epinephrine Epipen is the generic version with Epipen (brand) and Epipen JR (brand). There are two dosages of 2 autoinjectors of 0.15mg and 2 autoinjectors of 0.30mg. Adrenaclick is an alternative with Adrenaclick (brand) and epinephrine (Adrenaclick) generic.

The prices seem expensive -- that is why I am asking CarePlus to tell me how much I have to pay and maybe at another drug store as Publix seems pricey. I wouldn't know what is the best place to get them.

If CarePlus doesn't support the brand, then I need the generic and need to know how much and where to get my Rx filled. I would think the epinephrine (epipen) generic of 2 autoinjectors of 0.15mg would be the first option to consider.

Please let me know ... we have TONS of those Polistes carolina wasps here in Lakes at Leesburg! Not only in my yard, but the next door neighbors. The old guy sprayed 3 awnings that are in my side yard about 10 ft. away where wasps were flying on Saturday. It's Russian Roulette!
I received this reply on February 13th at 10:51am:
I checked Epinephrine auto Injector 0.15mg and is not covered. Please see the below alternative medications which are Tier 3 with a copayment of ($30$35. Please consult it with your doctor.
Epinephrine Epipen : What is the Cost?

At this point, I am still NOT SURE how expensive it will be for me to get an Epipen epinephrine prescription. Do I ask my doctor to write the prescription for the expensive brand and try to fill it at Publix and see of I am only charged $30 or $35? Or, do I ask my doctor to write the prescription for the so-called generic brand of "ephinephrine epipen?" At least I have been told that the auto-injector 0.15mg is not covered by my health insurance.

Googling "epipen ephinephrine" I found the GoodRx references which shows a host of different costs for the generic of "epipen ephinephrine." On that page, you can pull up the generic costs along with the two branded Rx's costs. It says, "Generic epinephrine is covered by most Medicare and insurance plans, but pharmacy coupons or cash prices may be lower." What I do note is that my Publix pharmacy seems to be one of the most expensive!!

Here is a comparison of GENERIC vs. BRAND costs for the epipen:

Prices and coupons for 1 package (2 auto-injectors) of epinephrine (Epipen) 0.3mg

Prices and coupons for 1 package (2 auto-injectors) of Epipen 0.3mg
I am scheduled to return to my doctor's office to have her nurse draw blood for a series of labs. What I think I will do is ask for an Rx for the generic epinephrine epipen and take that Rx to CVS Pharmacy rather than Publix. I'll let you know if I am successful.

Meanwhile, back at the farm! I also picked up a RESCUE! TrapStik for Wasps from HomeDepot. Within the first day, I trapped one Polistes carolina rust-colored wasp. With the help of a few experts from the University of Florida, this wasp was identified as the Polistes carolina. Supposedly, that wasp is not aggressive per se, but is a beneficial agent to Florida yards. However, the female will sting to protect its nest.

Polistes carolina rust-colored wasp on RESCUE! TrapStik
Polistes carolina rust-colored wasp on RESCUE! TrapStik
With a set of tongs, I removed the trapped wasp from the trapstik the following day. At the end of that next day, another Polistes carolina wasp had found the trapstik. I removed that wasp from the trap and put the trap back. One more Polistes carolina wasp was trapped and later removed. Thus far, that has been it -- 3 rust-colored wasps snared by the sticky trap. Oh, and I did happen to use Spectracide jet-spray to take out a 4th such wasp from the overhead beam in the carport.

Chatting with the old guy next door about my experience, as we stood there in my sideyard that is his backyard, we observed NUMEROUS Polistes carolina wasps fly to and from his awnings, gutters, and swing. He went to retrieve his Spectracide jet-spray to spray the three awnings along the back of his house along with the one side awning. He then sprayed into the gutter where a couple of wasps flew. Then, he checked the swing in his back sideyard. He mentioned having removed a wasp's nest from the bottom of that swing. And, also shared that he saw wasp nests in those awnings he just sprayed. HOLY SMOKES BATMAN!!! It is a bit of Russian Roulette here in Leesburg, FL.

The wasp experts from the University of FL said that the mild winter didn't kill off these wasps.

Epinephrine Epipen : What is the Cost? Do I get the auto-injectors? Do I opt for the generic over the more-expense brand? What other options do I have? Can I risk another serious, life-threatening allergic reaction by treating that with over-the-counter Benadryl? I suppose I could smash the pill into powder form so that it works faster. How about an inhaler with epinephrine -- might that be an option? It surely would be less expensive.

It is recommended that you seek medical attention after using an epipen. If that is the case, why not dial 911 and have the EMTs administer the epipen and provide immediate medical care? I just am not sure the best way to go. Hey, what a way to go ... I told my doctor that I was sure a heart attack or accident would kill me ... I never thought I'd die from wasp stings!!! You just never know, do you?

UPDATE: JUNE 14, 2019

It was pretty early in the morning to be out front in my garden picking up leaves and debris that blew in. I was near the front of my house bending over when I felt the familiar burning sting of a wasp. It got me pretty good in the middle of my back on the left side just under my bra strap. Right through my shirt! I did not see what type of wasp it was. I came inside to see the area on my back and could already see an oval raised area with two dark spots and a bright red area forming around it, almost like a target. I took a Benadryl but did not ice the area. An hour later, the oval swelling had dispersed to encompass a larger area of slightly raised swelling with the redness moving further along.

I bravely stepped back outside to that same area to see what wasp was hanging out. That's when I saw a wasp I wasn't sure of ... it seemed smaller than the Polistes Carolina and its body was darker, not orange or red. I noticed yellow stripes on its legs. Googling that wasp, I came upon the Polistes Fuscatus. "In addition to P. fuscatus, within Fuscopolistes are P. bellicosus, P. apaches, P. aurifer, P. carolina, P. dorsalis, and P. metricus, all of which are the closest relatives of P. fuscatus." So, this new wasp is related to the one that I know I am seriously allergic to! Oh, and it does state the the female has a venomous sting. It felt like that!