<instructions>Your goal is to analyze the following comment and estimate how highly it will be upvoted by the Hacker News community.</instructions><comment><author>dboreham</author><text>This is the whole point of the article btw : there have been &amp;quot;non-Mylan&amp;quot; EpiPen products on the market in the US for the past year (that are low cost) but they aren&amp;#x27;t magically associated with the SKU &amp;quot;EpiPen&amp;quot; in the Pharmacy -- you have request them by name. This news is about an alternative autoinjector being approved for that special &amp;quot;Pharmacist can substitute for the real thing regardless&amp;quot; status.&lt;p&gt;Source : son with severe peanut allergy and insurance that doesn&amp;#x27;t cover epipens. Made several trips to Canada (for other reasons); bought Epipens there for us and various friends.</text><parent_chain><item><author>mikeyouse</author><text>This isn&amp;#x27;t typically true -- If a doctor writes a Rx for Lipitor, it&amp;#x27;ll almost never be filled with the Brand Name Lipitor. All insurance and most formularies expect that the generic will be provided.  Doctors have to write &amp;quot;DAW&amp;quot; or &amp;quot;Dispense as Written&amp;quot; on the Rx for the patient to receive the brand name when a generic is available.&lt;p&gt;AJM Confirming that all states have Generic Substitution laws to lower drug costs:  &lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;www.amjmed.com&amp;#x2F;article&amp;#x2F;S0002-9343(10)01087-9&amp;#x2F;abstract&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;www.amjmed.com&amp;#x2F;article&amp;#x2F;S0002-9343(10)01087-9&amp;#x2F;abstrac...&lt;/a&gt;</text></item><item><author>da_chicken</author><text>&amp;gt; This got me thinking that consumers are at fault as well.&lt;p&gt;It&amp;#x27;s also partially the doctors.  If a doctor writes a prescription as &amp;quot;EpiPen,&amp;quot; then the pharmacist has to provide a drug with the brand EpiPen.  The doctor has to specify &amp;quot;EpiPen or generic equivalent&amp;quot; on the prescription in order for the pharmacist to be able to fill it with a generic.  If doctors don&amp;#x27;t realize that EpiPen is a name brand -- and &amp;quot;EpiPen&amp;quot; is so ubiquitous as to be nearly genericized at the point -- then doctors may not realize the issue.</text></item><item><author>forkerenok</author><text>From the article&lt;p&gt;&amp;gt; &lt;i&gt;Other epinephrine injectors have been approved before, but they struggled to gain market share against a brand that used lobbying and marketing to establish a virtual monopoly on the market.&lt;/i&gt;&lt;p&gt;This got me thinking that consumers are at fault as well. But then I read the following from the linked article[0].&lt;p&gt;&amp;gt; &lt;i&gt;“Their most brilliant maneuver, clearly, was giving them [EpiPens] away to schools and making it the thing that they could say, ‘Well, the nurse knows how to use it,’ ” said R. Adams Dudley, a pulmonologist at the University of California at San Francisco. “What are the parents afraid of? Their child will be away from them, and they won’t be there to use it. If they can say the school nurse knows how to use an EpiPen; she’s never seen an Adrenaclick ... It’s just a fear thing.”&lt;/i&gt;&lt;p&gt;With such (understandable) absolute risk averseness what is the way out?..&lt;p&gt;[0] &lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;www.washingtonpost.com&amp;#x2F;business&amp;#x2F;economy&amp;#x2F;2016&amp;#x2F;08&amp;#x2F;25&amp;#x2F;7f83728a-6aee-11e6-ba32-5a4bf5aad4fa_story.html&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;www.washingtonpost.com&amp;#x2F;business&amp;#x2F;economy&amp;#x2F;2016&amp;#x2F;08&amp;#x2F;25&amp;#x2F;7...&lt;/a&gt;</text></item></parent_chain></comment><story><title>FDA approves first generic version of EpiPen</title><url>https://www.washingtonpost.com/news/to-your-health/wp/2018/08/16/fda-approves-first-generic-version-of-epipen/</url></story>
<instructions>Your goal is to analyze the following comment and estimate how highly it will be upvoted by the Hacker News community.</instructions><comment><author>mjcl</author><text>But to date, delivery devices like the adrenaclick have not been considered equivalent to epipen. Some states permit a substitution in these cases (a &amp;#x27;BX&amp;#x27; rating instead of &amp;#x27;AB&amp;#x27;), but many do not allow it without getting clarification from the prescriber.</text><parent_chain><item><author>mikeyouse</author><text>This isn&amp;#x27;t typically true -- If a doctor writes a Rx for Lipitor, it&amp;#x27;ll almost never be filled with the Brand Name Lipitor. All insurance and most formularies expect that the generic will be provided.  Doctors have to write &amp;quot;DAW&amp;quot; or &amp;quot;Dispense as Written&amp;quot; on the Rx for the patient to receive the brand name when a generic is available.&lt;p&gt;AJM Confirming that all states have Generic Substitution laws to lower drug costs:  &lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;www.amjmed.com&amp;#x2F;article&amp;#x2F;S0002-9343(10)01087-9&amp;#x2F;abstract&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;www.amjmed.com&amp;#x2F;article&amp;#x2F;S0002-9343(10)01087-9&amp;#x2F;abstrac...&lt;/a&gt;</text></item><item><author>da_chicken</author><text>&amp;gt; This got me thinking that consumers are at fault as well.&lt;p&gt;It&amp;#x27;s also partially the doctors.  If a doctor writes a prescription as &amp;quot;EpiPen,&amp;quot; then the pharmacist has to provide a drug with the brand EpiPen.  The doctor has to specify &amp;quot;EpiPen or generic equivalent&amp;quot; on the prescription in order for the pharmacist to be able to fill it with a generic.  If doctors don&amp;#x27;t realize that EpiPen is a name brand -- and &amp;quot;EpiPen&amp;quot; is so ubiquitous as to be nearly genericized at the point -- then doctors may not realize the issue.</text></item><item><author>forkerenok</author><text>From the article&lt;p&gt;&amp;gt; &lt;i&gt;Other epinephrine injectors have been approved before, but they struggled to gain market share against a brand that used lobbying and marketing to establish a virtual monopoly on the market.&lt;/i&gt;&lt;p&gt;This got me thinking that consumers are at fault as well. But then I read the following from the linked article[0].&lt;p&gt;&amp;gt; &lt;i&gt;“Their most brilliant maneuver, clearly, was giving them [EpiPens] away to schools and making it the thing that they could say, ‘Well, the nurse knows how to use it,’ ” said R. Adams Dudley, a pulmonologist at the University of California at San Francisco. “What are the parents afraid of? Their child will be away from them, and they won’t be there to use it. If they can say the school nurse knows how to use an EpiPen; she’s never seen an Adrenaclick ... It’s just a fear thing.”&lt;/i&gt;&lt;p&gt;With such (understandable) absolute risk averseness what is the way out?..&lt;p&gt;[0] &lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;www.washingtonpost.com&amp;#x2F;business&amp;#x2F;economy&amp;#x2F;2016&amp;#x2F;08&amp;#x2F;25&amp;#x2F;7f83728a-6aee-11e6-ba32-5a4bf5aad4fa_story.html&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;www.washingtonpost.com&amp;#x2F;business&amp;#x2F;economy&amp;#x2F;2016&amp;#x2F;08&amp;#x2F;25&amp;#x2F;7...&lt;/a&gt;</text></item></parent_chain></comment><story><title>FDA approves first generic version of EpiPen</title><url>https://www.washingtonpost.com/news/to-your-health/wp/2018/08/16/fda-approves-first-generic-version-of-epipen/</url></story>