One solution to the soaring price of EpiPens: Build a replacement that costs a fraction as much. Jim Duren of King County Emergency Medical Services told KUOW’s Kim Malcolm that his agency did just that in 2013, building its own injection kit. “Excluding the medication, the kit itself costs $15 with all the supplies,” he said. And the doses of adrenaline? “Somewhere between $2.50 and 5.” And when the medication expires, it’s easy to replace for that $2.50 or so. Contrast that with having to pay hundreds of dollars for a new EpiPen. The cost of those EpiPens has risen sharply in recent years, and consumer wrath and congressional scrutiny boiled over this week.

But Duren, professional standards manager for the agency after a long career as a paramedic, said cost wasn’t the only factor that drove the county to build the kit. There was also a change in how paramedics decided which patients should get treatment with adrenaline in an emergency. “We would only administer the EpiPen when they were in dire need. So they were in anaphylactic shock,” he said. “And the new approach that the allergists were teaching their patients was if there were mild symptoms, administer epinephrine to prevent the severe allergic reactions.” Duren says his agency saved about $150,000 in the first year using the kits and now saves about $250,000 annually. That’s even though they’re used in more than twice as many situations than EpiPens were under the old protocol. The program has been so successful that King County EMS sells the kits (minus the adrenaline) at cost to other emergency medical providers across Washington and in seven other states. “We’ve been getting inquiries about twice a week from other states and counties about our program,” he said.