Vol. 6 No. 9 (2026): September
Reimbursement Recommendations

Intranasal Epinephrine (Neffy)

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Published September 29, 2026

Key Messages

What Is the Reimbursement Recommendation for Neffy?

  • Canada’s Drug Agency (CDA-AMC) recommends that Neffy be reimbursed by public drug plans for the emergency treatment of allergic reactions (anaphylaxis) due to insect stings or bites, foods, medicinal products, and other allergens, as well as idiopathic or exercise-induced anaphylaxis, in adult and pediatric patients who weigh 30 kg or greater, if certain conditions are met.

Why Did CDA-AMC Recommend Reimbursement?

  • Evidence from 5 studies (the EPI-15, EPI-16, EPI-17, EPI-18, and EPI-10 studies) showed that treatment with Neffy achieved plasma epinephrine concentrations and time to peak within the range observed with EpiPen and intramuscular (IM) epinephrine, with corresponding transient increases in blood pressure and heart rate in adults and children with type I allergies, adults with allergic rhinitis, and healthy adults. However, none of the studies evaluated Neffy in patients experiencing anaphylaxis or assessed whether Neffy improved outcomes that are important to patients, including symptom resolution, avoidance of hospitalization, and prevention of symptoms suddenly coming back. As a result, it is not completely certain if Neffy provides similar benefits and harms to EpiPen when used to treat anaphylaxis. Nevertheless, there is enough physiological evidence to expect that the effects will be comparable.
  • Based on the observed pharmacological profile and assumption of similar effects, the Canadian Drug Expert Committee (CDEC) determined that Neffy demonstrates acceptable clinical value versus EpiPen or IM epinephrine for the treatment of allergic reactions including anaphylaxis in adults and pediatric patients who weigh 30 kg or greater. This determination was sufficient for CDEC to recommend that Neffy be reimbursed. Given that Neffy is expected to be an alternative treatment option to EpiPen, acceptable clinical value refers to at least comparable value versus EpiPen.