For parents of children with severe allergies and for school nurses, now is the time to check the supply of EpiPens. That injectable medication can be life-saving in the case of a potentially serious allergic reaction.
But a Consumer Reports' check of retailers around the country suggests that the devices remain in short supply, three months after the Food and Drug Administration reported a nationwide shortage of the devices.
When the shortage first emerged, neither the FDA nor Mylan, the manufacturer and distributor of EpiPen and its generic version, would say how long the shortage might last.
Now, though retailers say supplies are slightly improved, in practice we found that it could be tough to find exactly what you need, when you need it.
Mylan said that it's still able to ship the epinephrine auto-injectors to wholesalers. But the company acknowledged that supplies at individual pharmacies may vary. Mylan still has not said how long the shortage will last.
The shortage of EpiPen and its generic version appears to be related to a warning letter the FDA sent to a Mylan supplier, Meridian Medical Technologies, in September 2017. The letter said the company failed to investigate hundreds of consumer complaints that the device did not work properly during an emergency. The FDA noted again recently that there are also shortages of a competitor product, generic Adrenaclick, made by Impax Laboratories, stemming from manufacturing problems.
A Consumer Reports shopper checked drugstores in Dallas, Denver, Des Moines, and Pittsburgh and confirmed some spot shortages. Here are some strategies to try if you can't fill a prescription for an EpiPen at your usual pharmacy.
Call around. No pharmacy we called was completely out of stock, but choices often were limited. For example, few had both generic and branded EpiPen and EpiPen Jr. available; often it was one or the other.
Representatives for CVS, Costco, and Walgreens confirmed that some of their stores might indeed have limited supply.
Costco, for example, said that more than 200 of its 519 stores had product on hand. A Walgreens spokesperson said that while many of its stores have EpiPen or generic products available, if one store is out of stock, other locations might have it. And CVS spokesperson Amy Lancot said that although the chain is not having widespread shortages, individual stores might temporarily be out of stock, and she encouraged patients to "call their local pharmacy ahead of time."
Plan for possible delay. Stores that were out of stock of particular products generally said they could order the devices, though it would probably take several business days for them to arrive. That was the case, for example, in the Denver area at a Costco, CVS, and Walgreens.
The online retailer Healthwarehouse.com said it is also experiencing a short delay. Joseph Peters, CEO of the U.S.-based company, said that it could take about five days before a product could be shipped. And Peters said the company currently cannot obtain one of the alternatives to EpiPen, generic Adrenaclick.
Ask Mylan for help. If you need help finding a store in your area, you could call Mylan. Sloane Miller, a therapist in New York City who works with allergy patients, says she called the company when her local pharmacy couldn't fill her EpiPen prescription. An hour later, she says, Mylan let her know that a nearby Duane Reade had the drug waiting for her. Call Mylan customer relations at 800-796-9526, then press 2. Customer service is open between 8 a.m. and 5 p.m. EST.
Ask about alternatives. Pharmacies that are out of your usual brand might be able to fill it with an alternative. For example, if you usually get an EpiPen, you could ask whether generic Adrenaclick is in stock instead. One grocery store pharmacy in Des Moines told us that it was out of low-dose EpiPen but did have generic Adrenaclick Jr. in stock.
Mark Donohue, CEO of Impax Labs, manufacturer of generic Adrenaclick, says he expects to have some supply available for the August back-to-school rush, but probably not enough to fully meet the demand. And he says the company doesn't anticipate having full inventory until the end of the year.
Note that your insurer might not cover those alternatives as well as it does your regular prescription. It's worth asking your insurance company whether it will make an exception because of the shortage. Another option is to look for a coupon on websites such as GoodRx.com or Blinkhealth.com, which offer discounts on many drugs.
Or another alternative: You could look into manufacturer coupons. The maker of Auvi-Q -- a new, high-tech epinephrine auto-injector that can cost up to $4,500 and is not experiencing a shortage -- has a copay assistance program for people whose insurance doesn't cover Auvi-Q well. And for those without insurance who make less than $100,000, you can apply to its patient assistance program. It can take several days to get the drug because your doctor will need to submit an application on your behalf and the company will need to review it to see whether you qualify.
Last resort: Don't throw away your old injector, even if it's about to expire. Hanging on to an expired epinephrine auto-injector is not ideal. It's only a short-term option to keep your old injector on hand until you can refill your prescription, provided that the medication in the injector is clear and colorless. An April 2015 study in the Annals of Allergy, Asthma & Immunology analyzed 35 expired EpiPens and found that injectors up to two years past their expiration date retained 90 percent or more of the initial dose listed on labeling.
(Don't use any injector if the medicine is pink or brown, is cloudy, or if it contains solid particles. That indicates the drug has decayed, according to Andrew Murphy, M.D., a board-certified allergist at the Asthma, Allergy and Sinus Center in West Chester, Pa. Read more about expired EpiPens.)
Last, call 911 immediately if you or someone close to you experiences a serious allergic reaction and you don't have any type of epinephrine auto-injector on hand.