If you're a parent of a child with life-threatening allergies, you know about EpiPens and the recent gigantic price hike.
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.
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.
Why the Increase in Cost of EpiPen?
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)
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 & Shady Deals
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.