The EpiPen Pricing Scandal & What You Can Do About It
If you or a loved one needs an EpiPen, you are likely aware of the runaway pricing of these life-saving medical devices. Find out about the EpiPen pricing scandal that's behind the price hikes, plus get information about cheaper EpiPen alternatives that can help you save lots of money!
I am very upset about this whole thing, but not just about the cost. I'm upset about what lurks behind the increased cost, and basically every detail surrounding this mess.
My oldest has life-threatening food allergies to multiple foods - dairy, egg, most nuts, peanuts, and sesame. Since he was diagnosed with these allergies, we have always carried Benadryl and at least one EpiPen with us.
For years we had insurance coverage that allowed us to get the EpiPen for only an Rx copay and so it was no big deal. We'd pay $10 - $40 yearly to refill the prescription for our son's EpiPen and that was that.
Things have changed, however.
With the costs of insurance skyrocketing, there have been annual changes with my husband's employer's healthcare plan, and now we have a high deductible plan.
So this year, when it was time to get a refill of my son's EpiPen, we went online to get the EpiPen coupon that we had always used, and went to the local Walgreens to get the prescription refilled.
This time, however, we got a big surprise.
Make that a $600 surprise.
The pharmacist rang up the cost of the EpiPen and asked me for $600+. I almost fainted, and then asked him about our coupon. Well, he went on to point out that there was fine print on the coupon (there really wasn't -- I guess it was on their website) stating that there is a maximum discount for the coupon and the maximum was about $100.
"What the heck was going on with this price increase, and what could I do about it?" I wondered.
So I found out. And it isn't a pretty story.
What is an EpiPen?
The "Epi" in EpiPen is short for epinephrine. Epinephrine relaxes the muscles in the throat that swell in the case of an anaphylactic reaction, thereby possibly saving the life of someone suffering from a life-threatening reaction to, for example, a bee sting or food allergy.
When someone has an anaphylactic response to an allergen, an EpiPen, or EpiPen alternative, can be an invaluable life saving device.
Why Did EpiPen Prices Go Up So Much?
There are a lot of fishy things going on surrounding the fast increase of the cost of the EpiPen.
The cost of the EpiPen was already increasing, but after a settlement with a pharmaceutical company to allow them to develop a generic, the price started increasing more rapidly.
“What we’re seeing from Mylan now is indicative of how many pharma companies negotiate during a momentary monopoly — they price as high as they can for as long as they can,” David Whitrap, a spokesman for Express Scripts, said in an email. (Source)
EpiPens make up 40% of Mylan's profits. The same item device sells in France for only $40. (Source) The EpiPen was only $50 - $60 several years ago. (Source) but now the cash price is at least $600.
Mylan has said that the increased cost of the EpiPen is due to improvements in the product (Source), but according to Michael Ray, the owner of Rx Savings Solutions, he knows nothing (emphasis mine) of anything regarding the costs of the components that should have impacted the cost of the EpiPen. (Source) Dr. Purvi Parikh, MD agrees, stating that the EpiPen hasn't changed in years. (Source)
He instead says that it is purely effective marketing. This article in Bloomberg concurs, stating that "“They have done a tremendous job of taking an asset that nobody thought you could do much with and making it a blockbuster product.” (Source)
I disagree. Marketing is a huge cause for the price increase as it increased demand, but the other side of the coin is -- No Competition.
As this article rightly states, there is a monopoly set up for the EpiPen and until the government gets out of the way and allows for competition, prices will stay exorbitantly high.
The CEO of Mylan stated that "Obamacare" has been the cause for people noticing the cost of the increase. In a sense she is right, but then isn't this just showing the mess we have gotten ourselves into? Obamacare has made insurance costs so prohibitive that more and more people are going to plans with high deductibles and no Rx copays, so now instead of paying a small copay or $0 for and EpiPen, like us people are paying the entire cash price. And of course, Bresch conveniently neglects to mention how much the cost has increased since Mylan started making the device.
Mylan's CEO Pay & the EpiPen Pricing Scandal
Heather Bresch, the daughter of Democratic Senator Joe Manchin (W. Va.) earned $2.4 million in 2007. Last year, she made $18.9 million dollars. Basically, her salary rose 600% while the price of the EpiPen rose 400%. (Source) I'm not for the government putting limits on salaries (except on their own), but I do think that the shareholders should protest this and that we should just take our business elsewhere.
Fine - if she has done such savvy marketing to make a huge profit for the company, so be it. But I think the gig is up. Time to buy epinephrine elsewhere.
What's even more disgusting is that the development of the EpiPen was done purely at taxpayers' expense. I know that we all value Research & Development in the drug industry, but come on. Plus, I would rather see R&D in the more natural realms of medicine when I see all of the side effects of drugs like antibiotics.
Mylan's Shady Reincorporation
This is where it gets really ugly.
Despite the price hikes, Mylan moved to further maximize its profit margins by engaging in a shady corporate accounting trick known as a tax inversion. In 2014, Mylan reincorporated in the Netherlands to lower its effective tax rate, despite its operational headquarters remaining in Pennsylvania. Despite even her own father saying Mylan’s inversion should be illegal, Bresch defended the inversion in an interview with the New York Times.
So the company just couldn't afford to stay in the US despite the sales increases and profit increases while they drove all of their competition out of the market?
See what high corporate tax rates (and corruption) get you? No tax -- that's what.
EMTs and EpiPen Alternatives
For families and individuals dealing with anaphylaxis, the increased expense of the EpiPen is becoming prohibitive, but for emergency responders, the issue is compounded because they need to purchase multiple devices per year.
According to this article, some EMTs are choosing to use epinephrine syringes instead of the epinephrine injectors in order to save money. (Source)
It's interesting to note the following emergency statistics in the above article, stating also that since switching to the syringes, they have seen no issues with safety:
Salt Lake paramedics and EMTs respond to close to 23,000 medical calls a year, according to the fire department.
Less than 120 calls deal with allergic reactions, and only seven with anaphylactic shock.
In fact, Illinois just passed a law allowing all EMTs to administer epinephrine using syringes instead of the overpriced EpiPens. (Source)
Still, the autoinjectors are much easier to use.
EpiPen Price Reductions
Under pressure, Mylan has recently agreed to increase the maximum value of the coupon to $300.
Thanks, Mylan. So now I can pay ONLY $350-ish for the mandatory Dual Pack that I will need a refill for next July, apparently, since that is when the pens at the Walgreens expired.
Of course, I could call all over town to see if another pharmacy has farther out expiration dates, but I don't guess that's the case, so it's probably not worth my time.
EpiPen Alternatives in the U.S.
Let me make this very clear--I am NOT going to buy Mylan's EpiPen this year.
Many are calling for congressional investigations into this situation.
This may or may not happen, and even if it happens, it might not have any good effect.
One easy alternative is for the public to just stop purchasing anything from Mylan.
In the interest of avoiding supporting Mylan, I did a bunch of research on EpiPen alternatives and found some lower cost options.
Go here to get in touch with GoodRx. Apply for the card that you can use in participating pharmacies. You can get Twin Pack of a generic epinephrine injector for $144.62 (price at time of publication). I've tried and with no result, so I will call again this coming week.
Still not cheap, but it's sure a whole lot better than paying more than $500.
Here is a list of pharmacies that might be participating in the GoodRx plan. Always call to check before going to the pharmacy.
Or, even if you live in the U.S., you can still order from Canada -- see the following for details.
EpiPen Alternatives in Canada
There are a number of places where you can get epinephrine injectors in Canada. I checked multiple Canadian sources, but the best price by far was Northwest Pharmacy.
Northwest Pharmacy quoted me $77.99 for a Single Epinephrine Injector plus $9.99 shipping. They will only accept check payments. Their Dual Injector is $144.79.
Yes, this stinks for the US Economy, so I would rather shop at GoodRx. Plus it's a slightly better deal than buying 2 pens from Canada, so that is my first recommendation.
The cash price of the generic epinephrine injector is still too expensive, in my opinion, but it's much better than $650-ish for 2.
I've already put a call in to our PCP to talk to him about this. I have previously self-administered injections and have given my son B12 shots, so using a syringe isn't a concern for me (though I would want training again), but a preloaded syringe like the type that the Salt Lake City EMTs are carrying would be the best option in that case for sure, to reduce administration time.
My son is extremely careful (even overly cautious) and we almost never eat out, therein limiting the chance of a severe reaction. But still, it's a concern and when you are dealing with a life-threatening issue, safety trumps expense.
Finally, I would like to add one bit of information. While you are sorting all of this out, if you have an expired EpiPen, keep it.
If you are in a situation involving anaphylaxis, an epinephrine injector that is 2-3 years past its expiration date still contains about 90% of its original epinephrine. And an injector that is 5-7 years old has approximately 70% of its epinephrine left. So it's better than no epinephrine but is not a good alternative to getting an up to date replacement. (Source)
Update 9/1/16: Please do not use any epinephrine that has become discolored and is brown or pink. There is a possibility that it could cause a hallucinatory reaction. (Source)
Besides going elsewhere to buy your epinephrine injector, please do your part and vote and educate. Get involved in the political process, get the cronies out and demand accountability from politicians, both locally and on the national level.
What will you be doing about the high cost of EpiPens?
Hi I just read this article and I am amazed at all of this. My husband has a peanut allergy and the other night he ate a cookie from a bakery we always purchase them fro and there must have been a peanut in it. He swelled up, got welts all over his body and then his breathing and swallowing starting to bother him. We couldn't find the epipen and he had to be rushed to the ER. He came home with his new script and I went to pick it up and was taken back by the price which it was a small fraction of your son's. We live on a tight budget and I dont have it in the budget for awhile for the $100 copay. Any new tips on how to get a bit of a discount or any kind of help. I have now become so nervous when he is putting something in his mouth...lol everytime he eats I am getting major anxiety..thanks for ur article
I'm so sorry that I forgot to respond. Did you check out the options in the post?
Thanks so much for the post.Really thank you! Great.
You are so welcome. Thanks!
Thanks so much for the post.Really thank you! Great.
The problem is corporation greed has won. They've lobbied and bought congress - they need to wear patches like race car drivers showing who owns them. Even worse is the greed doesn't trickle down. Trickle down economics only goes uphill. Congress stopped negotiations on drugs giving them the right to strangle us. We should be able to buy from Canada, should require that commercials stop, and that they should put more effort into drugs that do more that grow hair and men have sex. The main problem with insurance is again greed. The top dogs only want to bring money in- insurance was a scam to not insure anyone that needed it so they wouldn't have to put money out. People who developed high blood pressure or heart diesease were kicked out because omg they might need care. My husband had minor back and shoulder surgery but he was deemed to much of a risk - we could've gotten him insurance before obamacare or a new truck. Controls, real ones, need to be put on these monsters who have ruined lives. In Hell I hope they are poor and can't afford meds.
And I guess the biggest problem is big government that picks winners and losers amongst corporations. Make government smaller and these problems go away.
Hell is a place of perpetual torment. They cannot get even a glass of cold water for a million or zillion,!!!!!
excellent article on epipens! i carry one as well as my grown up daughter, she's more allergic than i am. One question: did you come across any info on what epinephrine breaks down into? some chems breakdown into toxic parts and some do not. that would be my one concern with expired pens
I'm sorry but I didn't find that information - were you able to?
Not yet, still researching that one and have my son-in-law helping with it as well. I'll post it here if I find anything substantial.
If you do a search on "thermal decomposition of epinephrine" you'll find several sites that have info on this, but, you need a chemistry background to decipher what the conclusions are. One site, Medscape, states that usage of degraded epinephrine (indicated by light brown or pink color) may result in a hallucinatory reaction. Waiting on son-in-law to decipher the rest of the findings (he is a chemist).
Thanks for that, Jose. I will make a note in the post. Please do check back once you hear.
Very well documented and worthy of further investigation! It's such a shame that these big Pharma companies are given the right to charge whatever they deem necessary for their drugs. I understand the wait time for them to get it to market, but if they are going to set a price initially, that is the price that should be kept as there isn't further need to research it! Greed is the only reason! I think it's high time that government gets out of the way of the people and allows them to make their own choices - intelligently.
Too bad the only 2 people running for office now are who they are - don't see too much changing, but then I could also be very wrong (have been in the past).
I too carry an epipen and am not the least bit impressed with what is going on, especially on a very small fixed income!
Thanks, Louise! Yes, and government lets them do it :(. I'm totally with you on government getting out of the way.
I'm not happy about the 2 people running, but of the 2, Trump seems to be less into big government. Hillary is clearly for "the bigger the better". Plus Trump is not for mandated vaccines so even though I am not happy with him, I am no way voting for her with all of the email corruption, Benghazi stuff and more.
Did you look into the other less expensive options? I'm trying to find out more about another one.
Thank you for writing this informative post Adrienne! It is really awful about the price increases, especially when peoples' lives depend on it. I used to carry one too, but thankfully my allergies have greatly improved due to changing my diet, especially time spent on the GAPS diet.
I also wanted to share a possible natural alternative: homeopathy. Homeopathy can be used for anaphylaxis. I have heard many times that Apis is an appropriate remedy - it may be Apis 200C or Apis 1M. Here is what the University of Maryland says about it (link: https://umm.edu/health/medical/altmed/condition/anaphylaxis):
Anaphylaxis requires immediate emergency medical attention. While the following homeopathic remedies have been used for allergic reactions, including symptoms of anaphylaxis, they should be given only under the guidance of a certified, trained homeopath in appropriate circumstances. Anyone experiencing anaphylaxis needs emergency medical attention, not homeopahty. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
Aconitum -- helps alleviate the tremendous anxiety and fear of dying that may occur during or immediately following an anaphylactic reaction
Arnica montana -- may be used in the case of shock or following a traumatic experience
Apis mellifica -- for puffy, rapidly-swelling skin following an insect bite or sting."
Hi Sarah! So you had anaphylaxis before you ate healthier?
Are you confident in homeopathy? I would be very very nervous to do that and of course it seems from the excerpt you shared that they are not recommending using it stand alone. Am I correct?
Hey Adrienne! Yes I did - a number of times. One time my dad had to administer it to me on a cruise ship because the ER/doctor's office was closed. Thankfully my last incident was almost 6 years ago, before I began changing my diet.
I am not confident in homeopathy. I would not recommend it over an EpiPen, but I have seen homeopaths suggest its use in these kinds of situations. I guess if it were your only choice and you didn't have an EpiPen and you had the homeopathy close by, you could start taking it on your way to the hospital. I have heard my former homeopath suggest taking remedies in an emergency on the way to the hospital or in the hospital.
Oh and you could take it together with the EpiPen! Homeopathy does not counteract drugs, but it is possible that drugs can interfere with homeopathy.
Wow. That's unbelievable. I wish we could have the same success here, but so far the only progress is that my son can have butter. Thanks for the clarification!
You're welcome! Be encouraged though - I think that any progress is worth celebrating!
I am encouraged. Thanks!
Thanks for writing this wonderful post! I have always wondered: Why does a competitor not step forward? Is there a patent or ?
Thank you so much Megan! There is a bit of information the competition issue in the post, but yes, there is a patent. Part of it ends in 2017. There are some competitors - the GoodRx one is working with one. I will make that more clear in the post.
This is a horrible example of price-gouging, but far from the only one. My 8yo daughter was recently diagnosed with type 1 diabetes and imagine my shock to find that one month of insulin costs $500 until we meet our high deductible. A little research reveals lots of recent price-hikes like the epi-pen and a similar lack of generic alternatives. This system is NOT working.
Yes, it is NOT working. So many systems are not working. When the government gets involved things get mucky. They have their place but it's horrid now. I'm so sorry that you have that situation. It's terrible!!!! I hope you have an HSA?
I saw Hillary speaking on this issue and she has put out a statement against Mylan's actions so I don't know that your commentary there is completely fair.
Source: (link is broken so it was removed by blog owner)
Hi Janice. Thanks so much for commenting. I am aware that she said this. Of course we all know that politicians say things that are expedient. If you read to the end of this article you will understand more of what I am getting at. And this does not mean that I think the GOP is a stellar example of ethics (in fact, quite the opposite), but Hillary has lied through her teeth before about Benghazi and her emails. Would you agree with that? https://reason.com/blog/2016/08/25/want-to-reduce-the-price-of-epipens-appr
I should add that I tweeted back to her tweet about Mylan calling into question her stating this after receiving so much money from Mylan. Did you see that Mylan was Bresch's father's largest contributor to his campaign? Of course you can give money and not get favors in response, but it doesn't seem to me that that is the way the Wash., D.C. works for the most part.
I dunno this election is a tough one! I feel like if we need any real change we have to start lower down on the totem pole and work our way up! I'm taxing my brain to figure out who I should go too about these outrageous drug prices! Every politician has their interests and their favors to fulfil so it's harder to control the big guys! It's not just epipen, it's generic drugs, HIV drugs a whole slew! Used to be you looked forward to the generic being cheaper! If you have no insurance you still get sticker shock! Mylan is a big manufacturer of genetics, so is Teva and apotex!
This election is just horrible.
I guess the best place to go about drug prices is for us to get as healthy as we can and avoid health issues as much as possible.
After that, local Congressional reps would be the next best place. It's hard, but we can keep trying.
Nope trump will never get my vote! I need someone who won't say something one day then flip flop just to get votes! I wish there were better candidates but I know who I definitely won't vote for. Can't say who I would vote for! Very tough decision ?? . That's why I'm trying to do more at the community level! Our healthcare system worries me so much!
I completely understand your concerns, Shelley. At the same time, are we sure he's really trying to get votes or perhaps his views have changed? I'm very skeptical of things but I also want to be reasonable. It's all very very tough. I saw Johnson just come out for mandatory vaccines and then try to backpedal on it but it sounded like leaving the door wide open to it. And really, it's going to be Trump or Hillary since the 2 Party is just the way it is right now. I don't like it but I'm a pragmatist in this situation. There are many politicians who have changed their views and have been sincere about it. Others - not so. One of the changes that Trump made really bothers me whereas the rest I can see reasons for. Of course, my assessment might be wrong and I am not always up on everything.
The healthcare system worries me a great deal and though I'm not a big fan of Carson either, I do like that he brought up the vaccine problem during the debates with Trump so that gives me hope in that regard. I hope it's clear that I am gravely concerned about Trump - I just guess I agree with Thomas Sowell in this article about Russian Roulette vs straight out blowing one's brains out. https://www.creators.com/read/thomas-sowell/08/16/the-political-picture.
I would be interested in what you think about it.
There are some people who argue that whom a candidate surrounds himself (or herself) with is more important than the candidate and so far I like who Trump is putting around himself. I saw an article on that the other day but can't find it now. Regardless, this is not a good situation, especially with where our economy is and the world turmoil. Thanks for reading!!
Thanks for the information about expired epipens. I am allergic to hornets and wasps and possibly to bees. My pen is 6 years old; my pharmacist told me that an expired pen was better than none plus I have to go to the hospital after using it anyway. I am in Canada but, until recently, without insurance for drugs. It was more than $100 when I bought it and the price I have heard recently is $120 - lots of articles about it since the huge price increase in the USA.
You are so welcome, Paula. I know it's all terrible. Did you see the $78 option I shared? In the US, Mylan has offered some at no cost, but that wouldn't help you, I assume. Might be worth looking in to.
Obamacare @&$&@?#%£. Sorry, I don't usually talk like that,but it just burns me up. I have a granddaughter that is allergic to all nuts, shellfish, and other things. She is 14 and has only used her EpiPen once, when she was five. She is very carefull about what she eats and if you can't tell her for sure that something is nut free, she just want eat it. She has been a label reader since she was five. Anyway, I agree with what you said. It's not just food allergies, there have been several people in our part of the country (southeast) that have died from fire ant bites...reportedly because they did not have an EpiPen. I could go on, and on, but I won't. Just know that my thoughts and prayers are with your family and other allergics.
I am not happy about Obamacare (poor title for it in my humble opinion) either. I hadn't heard about fire ant deaths. That's terrible. Thank you for your thoughts and prayers and I hope there is more competition soon. Thanks for reading.
I've heard a friend call it "Obamadon'tCare
I concur. The free market should sort things out. Get corruption and the government out of it as much as possible.
Does anyone have any experience with the Christian health sharing organizations? I know they are cheaper but then some have stipulations for pre-existing conditions!
Do you mean in general or in relation to the EpiPen situation?
In general! I wonder if their coverage is better!
I assume it varies by the group. I know that pre existing conditions can be an issue and also I believe that their coverage for auto injuries are quite low so if you join one you need to up your auto medical coverage to the max.
When I was a kid, aBout 45 years ago, I had a near fatal reaction to bee stings. My doctor put together a kit for me to carry. It contained a glass ampules if epinephrine and a syringe with needle attached. It wasn't as fast and easy as an Eoipen, but it worked. It probably cost about a dollar.
I am sorry you have that allergy. So how would you feel about carrying that now as far as speed and accuracy. Do you carry something now? I have heard that the epinephrine only costs about $1 in developing countries. It's amazing the disparity in the pricing.
My concern with this option would be that it's less likely that a non-family member/bystander/etc. would know what to do with this in an emergency. (Shoot, I don't even know what to do with an epi-pen, since we don't have any anaphylactic allergies in my household, but I'd think it would be easier to sort out on the spot than a needle and a vial.)
Hi Rachel. Nice to hear from you. Which option are you talking about? The needle and vial? I recommended very very similar devices to the EpiPen and am investigated others. The GoodRx one is a very close alternative from what I can tell.
I'm looking into another autoinjector. Just got off the phone w/ the manufacturer and am going to run it by my PCP.
I'm talking about Fred's recommendation of an ampoule of epi and a syringe.
Don't get me wrong; I'm ALL for buying from someone other than Mylan. It angers me beyond words that they would price-gouge over something literally life-or-death. I just wonder if someone other than a parent or routine caregiver would be able to figure it out.
Got it. I hope to have that other alternative soon. It looks like a great one to me. Yes, I am concerned about the plain syringe too.
No doubt, the Epipen is easier and less chance of messing up. I think the choice on whether to use a syringe or not (you can pre load them and they are good for 6 months or so) depends on each person's situation. My husband is allergic to bees. But when he gets strung, he has sevreal minutes to react and get to some epinephrine. He or I could easily do an injection in time. (And this is what we are going to use from now on.) I am fairly confident my 11 year old could do it too with a little training (she has done injections on animals). But with a younger kid, away from home or in other people's care, a person with a more severe allergy, an auto injector is probably the way to go.
A glass ampoule of epinephrine and needle costs $1. There is no need to buy an EpiPen.
Thank you for all of the useful information that you have shared.
I am a recently retired school nurse and I am concerned about families being able to provide Epi-pens for school and/or childcare, and home. This price increase is putting these children at risk.
I would like to also request that you insert a different photo to accompany this article.
I have taught literally hundreds and hundreds of staff, students, and families how to administer an Epi-pen and the photo does not show the correct technique. (Wrong site, the blue cap is on, and you NEVER put your thumb on the end of the auto-injector). As you know - the more people that know how to correctly administer an Epi-pen, the safer those with food or insect allergies are.
Thank you, Debita. I appreciate your concerns about the photo. I just put a disclaimer in the post and I will try to change out the photo when I can. There were very few photos on the site where I bought it from and not many available on other sites. I alerted the photo site as well. Thank you!
The affordable Care Act needs so much work and I hope that someone in congress plans on continuing to make it more 'affordable'! Insurances have started pulling out because it's just too expensive! By the way good rx has a phone app where you can download it right on your phone! Just provide the pharmacy with the ID, group, bin and PCN! I recommended that card all the time when I worked at Walgreens! Btw Walgreens also tried that tax inversion when they got a new owner but it didn't work!
It's so not affordable. When you make something free it just doesn't work. If you made food free, everyone would get much more than they need in the store and the store owner would charge as much as he could. And the system would break. Same thing here. I think it's meant to break.
Thanks for the tip on the GoodRx! How did you get your card?
They should make Mylan come back to the US. It stinks.
No physical card needed, just get the app and search for the drug the same way you did it and when you click on the pharmacy it will give you the info!
Oh interesting. They told me on the phone I needed to sign up - did you do that?