EpiPens in Canada: Pharmacies Face a Month of ‘No Inventory’ of Main Auto-Injector

in Food Allergy, Food Allergy News
Published: July 31, 2018

Updated August 2, 2018 – The supply of EpiPens (0.3 mg strength) in Canada has now reached a critical shortage. [Editor’s Note: This shortage  resolved later in the year.]

While some pharmacies may have very limited inventory, Health Canada, the country’s health regulator, warned on July 30 that this “will likely be depleted in the coming days or weeks.” Pfizer Canada, which markets the life-saving epinephrine auto-injector for allergic reactions in Canada, does not expect to be able to provide new supply until the end of August.

“We are anticipating a period of four weeks where no inventory of EpiPen 0.3 mg will be available,” Christina Antoniou, senior manager of corporate affairs at Pfizer Canada, told Allergic Living. “This period is expected to last through the month of August 2018.”

The EpiPen Jr, designed for children up to 66 pounds (30 kilograms) at a smaller dose of 0.15 mg, is available at Canadian pharmacies, but even that supply is limited, with pharmacists usually only allowing the purchase of one device per customer.

The EpiPen brand is the only auto-injector currently on the market in Canada.

For Canadians experiencing difficulty locating an EpiPen, Antoniou says to call 1-877-EPIPEN1 for assistance in finding a pharmacy with the device in stock.

Using Expired Injectors

During the shortage, Health Canada recommends in an anaphylactic emergency that Canadians use an expired auto-injector, if that’s all that is available. The agency reminds of the protocol to administer the device, and then contact 911 immediately.

Pfizer Canada says the EpiPen shortage, which began in January, is due to manufacturing issues. Pfizer Inc., based in New York City, owns the subsidiary that manufactures the EpiPens and generic equivalent auto-injectors which the pharmaceutical company Mylan markets to U.S. distributors. Pfizer Inc. has faced manufacturing delays that have led to shortages in the U.S., U.K. and Australia, as well as Canada.

Actions Being Taken

In the House of Commons, Canadian opposition parties pressed this week for the Liberal government to address the shortage of EpiPens in the country. The NDP is urging the Liberal government to take necessary steps to prevent future supply issues of the life-saving drug.

“The Minister of Health should never have allowed this dangerous situation to develop, and now it’s on her to fix this immediately,” NDP health critic Don Davies said in a press release. The Conservatives argue the government should push for the development of a Canadian-based supply chain.

The non-profit Food Allergy Canada is speaking to suppliers that are approved to market other brands of epinephrine auto-injectors in Canada. “We need a second supplier in the market at a minimum,” says Jennifer Gerdts, executive director of the advocacy group.

U.S. Shortage Situation

In the United States, there are still some intermittent shortages of Mylan’s branded and generic versions of EpiPen and EpiPen Jr, although an earlier shortage situation, with numerous back orders, appears to be improving. There are also other auto-injector choices, such as Auvi-Q and Impax’s generic auto-injector. Mylan suggests U.S. consumers call its 1-800-796-9526 hotline for assistance in finding a set of its devices.

Antoniou says when Pfizer Canada once again receives inventory of the regular EpiPens, they will be “placed under allocation” and the company will “continue to manage supply carefully until re-supply of the Canadian market is returned to normal levels.”

While the news media often refers to the EpiPen 0.3 mg auto-injector as “adult size,” the device is prescribed to anyone with potentially severe allergies who weighs more than 66 pounds/30 kilograms. That includes most older children and teens.

Informal Toronto Survey

The seriousness of the Canadian situation was underscored in an informal in-person and phone survey of pharmacies that Allergic Living conducted on July 30, 2018 in the Toronto area. Allergic Living staff found that a dozen drugstores had no stock at all of the EpiPen, but all did have stock of EpiPen Jr available.

Most of the pharmacies recommended to keep phoning other pharmacies to locate an auto-injector, while one pharmacy clerk said that he thought we were unlikely to find one “in all of Ontario.” His recommendation was to drive to Buffalo, New York, where the price with drug insurance would be about $600 USD for a two-pack set, instead of about $135 CDN for a single device (in Canada, the devices are sold individually).

However, while EpiPens can be purchased over the counter in most of Canada, a doctor’s prescription would be required for a U.S. purchase.

Allergic Living first reported on the supply shortage in Canada in January 2018 and at that time, Health Canada said the shortage was expected to be resolved in March 2018.

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