More than 30% of community pharmacies say they cannot order supplies of EpiPen (Mylan) auto-injectors as they are out of stock, despite the device’s sole distributor Alliance Healthcare stating they are available.
Mylan, has introduced a prescription validation process for EpiPen 0.3mg and EpiPen Jr 0.15mg, to help manage supply and demand, by limiting supply to two adrenaline auto-injectors (AAIs) per patient.
However, a survey of 100 community pharmacies in England, carried out by Channel 5 News and shared with The Pharmaceutical Journal, found that 31 pharmacies said they could not order AAIs because they were “out of stock”, and a further 22 said they were “unsure” if they could supply them. Of these 22 pharmacies, half said they would try ordering, but added that there was no guarantee they would arrive; 6 pharmacies said they did not know if they could supply or if the order would arrive and 5 pharmacies said they would not know if they could supply until the script was faxed.
The survey revealed that just 5 of the pharmacies asked had AAIs “in stock” and 42 pharmacies said they could order stock and expected supply.
Mylan first highlighted supply issues with its 0.3mg EpiPen in May 2018 and, in a further update in September 2018, also confirmed that the problems were also affecting the EpiPen Junior 0.15mg. As a result, pharmacists were allocated products on a prescription-only basis and could only place orders for two per prescription.
In October 2018, the Department of Health and Social Care (DHSC) and NHS England issued national guidance for community pharmacists across England advising that children weighing 25kg or less had the “greatest short-term need” and should have first call on any 150microgram AAI products available.
At the end of November 2018, NHS England announced that “sufficient stock levels” of all three brands of AAIs were available, but that wholesaler prescription validation would remain in place for EpiPen until “further notice”. The prescription-only process was then re-introduced by Mylan in June 2019.
Despite this, a spokesperson for the DHSC reiterated that the UK had “sufficient supplies” to meet the normal requirements of those who need an EpiPen and other AAIs.
“All patients who require an AAI should be able to obtain a device from their pharmacy. We continue to work very closely with all the manufacturers of AAIs to ensure supplies remain available in sufficient quantities to support demand,” they added.
A spokesperson for Boots said there “continued to be issues with the supply of adrenaline injector pens”, but added that patients with a script could access prescriptions from their pharmacy via the script validation service for many lines, with a 36-hour turnaround.
A spokesperson for Mylan said that the company had taken several steps to help manage product availability on an ongoing basis until a steady supply resumed, including the implementation of a prescription validation process which pharmacists were alerted to when they attempted to place an order for EpiPen.
Amanda Smith, the manager of an independent pharmacy in Halifax, said: “We have been able to order the 0.15mg EpiPen using the normal online ordering channels, but if we need any of the 0.3mg [EpiPens], we have to send an anonymised copy of the script to Alliance”.
“We cannot order them until we have a script to send, so we are unable to keep any in stock. If the order goes through OK we generally get the stock the following day, but there have been occasions when it’s taken 4–5 days.
“This is causing a lot of worry for patients who are, understandably, frightened if they cannot get hold of their adrenaline pens.”