EpiPen Fill Rates Are Lower Than Past Years — Is COVID-19 to Blame?
Key takeaways:
Fills for EpiPen are lower than expected as fewer kids head back to school.
In August, when prescriptions typically peak, fills were down by 36% compared to prior years.
For children with a severe allergy, the beginning of a new school year means a new EpiPen prescription. During the back-to-school months of September and August, fills for EpiPen normally spike as parents and schools scramble to refill the autoinjector, often spurring shortages. But this year is far from normal.
As the COVID-19 pandemic continues, many schools have switched over to virtual learning, and now for many students, the classroom is in their home. As such, fewer families and schools are stocking up on their EpiPen this year, and fills are subsequently down.
EpiPen fills drop by almost 40%
This August, fills were 36% below where they were in past years. During a normal year, fills for EpiPen and generic epinephrine account for 0.25% of all prescription fills. This year, though, they only accounted for 0.15% of all fills.
On top of this, data shows that starting in January 2020, fill rates for EpiPen were already below average. The fill rate then was 19% lower compared to the expected fill rate in January from previous years.
California and Michigan see some of the biggest declines in fills
Fills for EpiPen nationwide are lower than expected, but this trend is deeper in some states than others. In August, two states that saw the biggest shortfall from expected EpiPen fill levels were California and Michigan. Fills were 45% and 35% below projected levels in these states, respectively.
In Florida, EpiPen fills were 26% below expected levels despite the state having a similar percentage of students in remote learning as Michigan. Florida may have a lower decrease in fills compared to Michigan, however, because more of its students are attending school in person — 49% of Florida’s students are attending in-person and hybrid classes, while only 44% of Michigan’s students are attending in-person and hybrid classes.
Data collected by Education Week shows the percentage of students who will be learning remotely in each state. Based on data from selected districts, California, Michigan, and Florida all have at least half of their students learning remotely, which could explain why their EpiPen fills are lower than other states:
In California, 99% of students (1.93 million) out of the total (1.934 million) will be remote learning only out of the districts with data provided.
In Michigan, 55% of students (98,841) out of the total (179,606) will be remote learning only out of the districts with data provided.
In Florida, 50% of students (1.25 million) out of the total (2.47 million) will be remote learning only out of the districts with data provided.
Education Week’s data was not comprehensive, but it did include the largest districts in each state and at least five districts from each state. This data was intended to provide a look at how the districts in each state are beginning the 2020-21 school year.
These reopening plans are also conditional and may change depending on the number of COVID-19 infections and health guidelines from state and local authorities.
Summing it all up
COVID-19 has shifted many of our daily activities, including how and when we fill our prescriptions. This school year is starting for many students in a way that they are not familiar with, and it may have changed some of their normal preparations. This substantial drop in EpiPen fills in August compared to what is expected is an example of how things may be changing due to COVID-19.
But it may not be all bad news. EpiPen autoinjectors commonly fall into a shortage at the beginning of the school year. But now, without the mad rush to the pharmacy, EpiPens and the generic epinephrine are readily available.
Co-contributor: Jeroen van Meijgaard, PhD
Methodology
Using a representative sample of U.S. prescription fills, we calculated the monthly share as the number of fills for epinephrine injectors divided by the number of fills of all drugs, after removing drugs with a seasonality component in prescribing patterns. The projected share for August 2020 is calculated by using the share of fills in January and February, and applying the rate of increase to August from prior years (2014 to 2019). Actual share of fills are compared to the projected share of fills by state to evaluate the shortfall for August 2020 by state.
District reopening data was pulled on September 3, 2020 from Education Week:
The percentage of students remote learning by state was calculated by taking the number of students in districts with a remote-learning-only plan and dividing it by the total number of students in all districts and all district reopening plans within that state. Percentage of students attending in person and hybrid classes by state was calculated by taking the number of students in districts with in-person and hybrid classes and dividing by the total number of students in all districts and all district reopening plans within that state.
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