Coverage: What’s behind the price increase of an EpiPen?

Mylan NV is coming under media scrutiny because since 2007, the price of an EpiPen — used to treat anaphylactic shock in allergy victims and people with asthma — has quietly risen 400 percent.

Jacqueline Howard of CNN had the news:

The EpiPen is an auto-injector that delivers epinephrine, more commonly known as adrenaline, a hormone that can help to relax muscles. It can open the airways, and reduce swelling during a severe allergic reaction.

Indeed, the price of an EpiPen standard two-pack gradually grew to about $600. The same two-pack cost only about $100 in 2009.

Meanwhile, epinephrine, which can be purchased alone, costs just a few dollars. The EpiPen, manufactured by the pharmaceutical company Mylan, offers a portable way to administer doses. “Some patients and physicians are resorting to buying epinephrine ampoules and filling their own syringes,” said Dr. Thomas Casale, a professor of medicine at the University of South Florida and executive vice president of the American Academy of Allergy, Asthma, and Immunology(AAAAI).

Many adults and families of children with severe allergies are facing sticker shock when they pay for their EpiPens, especially amid back-to-school season.

Emily Willingham of Forbes.com looked at the marketing strategy behind the pricing:

It’s what the market will bear, so what’s the problem, right? Only this: Somewhere, right now, a cash-strapped parent or budget-limited patient with a severe allergy will skip acquiring an EpiPen. And someday, they will need it in a life-threatening situation involving exposure to a trigger…and they won’t have it. And they will die. Because they couldn’t afford the delivery mechanism for $1 worth of a drug to keep them alive. Two turning points, a death and one company at the crossroads.

According to NBC, Mylan’s profits from selling EpiPens, which they have aggressively, famously marketed with brilliant success, hit $1.2 billion in 2015. That year, Bloomberg reported that the epinephrine-delivery system represented 40% of Mylan’s operating profits. Bloomberg calls Mylan’s marketing of the EpiPen “a textbook case in savvy branding.”

That savvy comes at steep and increasing individual cost. Even after insurance pays, the customer can be out $400 or more for a pack of two pens, a dollar value that can vary depending on how high the deductible is. And most customers need EpiPens for home and at school for their child (Mylan does have a program that offers free EpiPens to U.S. schools). Indeed, guidelines call for prescribing two doses in case the first one fails, which Mylan used as an opportunity to cease selling single pens and begin selling only two-packs.

Jake Novak of CNBC.com looked for a solution to the issue:

Don’t get me wrong, I’m sure we could find a few dozen drug-abuse obsessed people in this country who can and will find a way to abuse their EpiPens. But should the government be acting more aggressively to stop these obviously self-destructive people or should it be concentrating on doing what it can to help the millions of people who are trying to be personally responsible and stay alive? That’s the choice, after all.

And with that in mind, just who is the government protecting by keeping epinephrine auto-injectors by prescription only? It’s obscene and scary that responsible people who want to protect their health have to pay more and go through the tedious and sometimes expensive process of getting a prescription in order to protect those who want to abuse their health and might … just might … choose to use their life-saving drug or device to abuse it.

Over the counter or not, there will still be costs connected to reasonable testing of the auto-injector by government regulators. No one is arguing against that. And the FDA still regulates over-the-counter drugs in many other ways. But OTC medicines put a lot more responsibility into the hands of the actual people who use them. Pharmacists will also need to become more educated about advising customers on the injectors’ proper use and maintenance.