Shuffling Along the Cost: EpiPen

You may have heard about the latest crisis in rising healthcare costs: EpiPens.  The cost of a two-pack of EpiPens has increased 450 times since 2004 to its current price of $600. [1]

By Chemistryroxpharmacysux (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons(source)

What are EpiPens?

They are a patented injection delivery system for epinephrine, meant to stop anaphylaxis from killing a person who’s suffering an allergic reaction.  EpiPens expire after a year due to the epinephrine becoming degraded due to light and heat exposure over time. [2]

If EpiPens are so life-saving and necessary, why aren’t there generics available?

A multitude of reasons: The competitor Sanofi’s Auvi-Q was recalled last year due to improper dosages.  A similar and less-costly product called Adrenaclick, exists, but the delivery method is different than EpiPen.  Epinephrine itself only costs $1, but manually injecting oneself with a syringe in an emergency situation is inadvisable without medical training. [3] The FDA is slow to approve generic drugs due to backlog, which delays competitors from entering the market. [4]

Can’t the government do something?

Why, yes, Mylan has quite an interesting history as government lobbyist.  Both through its own power and through millions in funding to patient advocacy groups, Mylan was instrumental in pushing a 2013 federal law that “encourag[ed] schools nationwide to stock EpiPens.” [5] Mylan also previously paid Dr. Leonard Fromer, assistant clinical professor of family medicine at the University of California, Los Angeles, as a consultant.  Dr. Fromer was not on their payroll, however, while he authored a paper published in the American Journal of Medicine, in which he recommended that EpiPens be added to the federal list of preventative medical services. [5] That brings us to solutions for “the [EpiPen cost] is too damn high” dilemma. [6]

Supposed Solution 1: Getting EpiPen on the federal “A-List” of preventative medicines

Including EpiPens on this list would make them, on the surface, free for consumers.  The buck has to stop somewhere, though, as Mylan is not inherently lowering the price for the drug.  So who’s stuck with the bill?  Your health plan, your employer, and you…  The health insurance plan pays the full cost, raises premiums for your employer, and your employer passes that onto—guess who?!—the consumer, in the form of higher pre-tax payroll deductions.  If you have Medicare or Medicaid, you would not pay anything (but you are also earning under the federal poverty level for your household size, have a disability or other qualifying condition, or are over 65.  Also, you’re ineligible for solution #2).  Would you rather pay that $608 up front at the pharmacy, or pay a higher overall premium for your health insurance? [5]

Supposed Solution 2: Copay Discount Cards

Mylan recently increased its copay discount card offer from $100 to $300, but the 50% discount on a pack of EpiPens only lasts ‘til the end of 2016. [7] Again, copay discount cards are another form of cost-shuffling, since someone, somewhere, is still paying the full price, even if the consumer isn’t at their local pharmacy. [8]  These cards are a temporary solution, at best.

 

What’s a consumer to do?  At the moment, consult your local patient advocacy group…and make sure you know who’s funding them.


 

[1] http://www.marketwatch.com/story/mylans-epipen-price-increases-are-valeant-like-in-size-shkreli-like-in-approach-2016-07-20 ; https://www.statnews.com/2016/07/06/epipen-prices-allergies/

[2] http://www.consumerreports.org/drugs/expired-epipens-what-you-need-to-know/

[3] https://www.statnews.com/2016/07/06/epipen-prices-allergies/

[4] http://thehealthcareblog.com/blog/2016/09/03/epipeneconomics/

[5] http://www.nytimes.com/2016/09/16/business/epipen-maker-mylan-preventative-drug-campaign.html

[6] https://en.wikipedia.org/wiki/Rent_Is_Too_Damn_High_Party

[7] http://www.webmd.com/allergies/news/20160825/true-cost-epipen-coupons

[8] http://www.deseretnews.com/article/765689363/The-pluses-and-minuses-of-drugmakers-discount-cards.html

 

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