On a recent trip to a friend’s farm in East-Central Texas, I couldn’t resist my childish and “former gymnast” urge to climb a magnificent 100-year-old tree on the property. My friend’s caution to watch out for ants came as I was already atop a massive branch, and sure enough: I looked down and saw several ants on my arm. Not a big fan of anything that creeps and crawls, I brushed them off, got out of the tree, and headed back to the house.
What unfolded in the following 20 minutes shocked me. The spot on my arm where the ants had been started to itch and didn’t improve after I applied After Bite. The itchy spots started to puff up and multiply. The hives that followed spread from my arms to my legs and soon to my entire torso. I decided Benadryl might help, so we headed to a pharmacy. Halfway down the farm road, I asked my friend to turn around so I could go get my insurance card: my throat was starting to close up and I knew I needed to get to an emergency room. My uneducated guess was that I was allergic to ant bites.
The emergency room doctors confirmed just that: I was on the verge of anaphylaxis. If you’ve ever seen the movie Hitch, you might recall the scene in which Will Smith’s character has an allergic reaction. That was me.
I can laugh about it now, but at the time it was scary: my entire body was covered in hives, my face was swollen, my left eye was nearly shut, my scalp itched like crazy, I had the chills and was shaking uncontrollably, I couldn’t swallow, and I was having difficulty breathing. An IV of steroids, Benadryl, and epinephrine, and a three hour nap (during which I’m fairly certain I cursed at an insurance representative on the phone) later, I was discharged.
I wasn’t looking forward to the ER bill, but the first of several rude awakenings came the next morning when I stopped at a pharmacy to pick up the steroids and the EpiPen the physician had prescribed. The steroids: less than $4. The EpiPen two-pack: $565. More cursing. Another phone call to my insurance company, and I learned that that is, in fact, what the EpiPen cost with my insurance. Having been born and raised in Austria, where health care is socialized and essentially free, I was outraged.
As it turns out, I wasn’t alone. EpiPen manufacturer Mylan recently found itself in hot water after national media outlets, elected officials, and public figures honed in on the 400% price increase the company’s patented epinephrine auto-injector took over the last seven years. A life-saving device, critics agree, should not and cannot be unaffordable to a vast percentage of the population.
Hillary Clinton called it “outrageous,” Bernie Sanders “egregious,” and the White House “greedy.” Another tidbit: EpiPens have to be replaced every 12-18 months, and medical professionals recommend always carrying two in case the first isn’t enough to get you to the ER.
Here’s some background on Mylan: The company acquired EpiPen in 2007. In 2012 it settled a lawsuit allowing its competitor Teva to market a generic version of the epinephrine auto-injector starting in 2015.
Perhaps the looming threat of losing market share to a competitor caused Mylan to increase its price point: after two 10% annual price hikes, Mylan increased the EpiPen’s price by 15% twice per year beginning in 2014. The list price, therefore, went from slightly more than $100 in 2007 to more than $600 for a two-pack injector today.
The FDA rejected Teva’s generic in 2016, pushing its launch back until at least 2017 and leaving the market monopoly on epinephrine injectors tightly clutched in Mylan’s hands.
So then why the massive price hike? The answer depends on whom you ask.
In an interview with CNBC, Mylan CEO Heather Bresch was quick to refer to an “outdated,” “inefficient,” and “broken” healthcare system that forced the company to up the price over the years. She cited research and development, legal proceedings, pro bono initiatives, enacting legislation, the “four or five hands that the product touches and companies that it goes through before it even gets through to that patient at the counter,” as well as rising insurance premiums, deductibles, and co-pays as reasons for EpiPen’s dramatic price increase.
The interview has since gone viral and reminded many of controversial interviews and the highly publicized testimony – or lack thereof – of “pharma bro” Martin Shkreli, former CEO of Turing Pharmaceuticals. Bresch’s statement, “No one’s more frustrated than me,” caused a national furor, especially since her salary went from $2.5 million to nearly $19 million between 2007 and 2016.
To read the full interview transcript, click here.
In an attempt to pacify public outrage and “make sure that everyone who needs an EpiPen has an EpiPen,” Bresch announced that Mylan would be introducing a $300 “savings card (that) is equivalent to cash.” She explained that the rebate card, which goes “around the system” and is available on Mylan’s website, slashes the price in half.
Experts, however, have said that this is a classic pharmaceutical company PR move that will likely only benefit a small number of patients: people without insurance and those enrolled in government-funded health programs like Medicaid, for example, are excluded. Furthermore, the discount card requires patients to take extra steps, whereas reducing the list price – a viable long-term solution to the problem – would not.
“Mylan should not offer after-the-fact discounts only for a select few – it should reverse its massive price increases across the board immediately,” Rep. Elijah E. Cummings (D-MD) said in a statement. He added that he had requested a hearing by the House Committee on Oversight and Government Reform to discuss the issue in September.
Mylan’s next tactic was to announce the release of its own generic auto-injector identical to EpiPen that goes for $300 wholesale. The company will now offer the same product under two different names and at different price points, which, again, has led many to ask, “Why not just cut the wholesale list price?”
“The weirdness of a generic drug company offering a generic version of its own branded but off-patent product is a signal that something is wrong,” Robert Weissman, president of the consumer group Public Citizen, said in a statement to the New York Times. “In short, today’s announcement is just one more convoluted mechanism to avoid plain talk, admit to price gouging, and just cut the price of EpiPen.”
Shkreli, too, weighed in on the EpiPen controversy, saying that insurance companies carry the bulk of the blame and that they should “love to pay for this stuff (EpiPens),” because it could potentially save them from having to cover tens of thousands of dollars in emergency room costs.
On an individual level, Shkreli said the EpiPen “is actually a bargain. At $300 a shot … it saves you all the cost of going to the emergency room. … My iPhone is $700. … It’s $300 and 90% of Americans are insured.”
Not in Texas, they’re not.
What Shkreli and Bresch agree on is that the healthcare system incentivizes higher drug costs to consumers. “Mylan is the good guy,” Shkreli said. “They had one product, and they finally started making a little bit of money and everyone is going crazy over it. Like I said, it’s $300 a pack.”
Mark Baum of Imprimis Pharmaceuticals disagrees. He’s called Mylan’s continuous price hikes “shameful” and has announced his company’s $100 EpiPen version, slated for release by the end of 2016. This isn’t the first time Baum has capitalized on fellow pharma companies’ scandals. Following the outrage over Daraprim, the drug used to treat malaria and HIV that Turing jacked up by 5,000% to run $750 a pill, Imprimis launched a $1 alternative.
While Baum commended Bresch for being “honest” about the larger issues in the healthcare industry and said she was right to raise Epipen’s price, he added that she shouldn’t have raised it that much.
“I don’t need to make $19 million a year,” Baum said to CNN. “That’s not how I want to live my life.”
I don’t make millions and neither do thousands of others who have to carry an EpiPen as a precaution at all times. While many of us can afford to pay $565, we shouldn’t have to.
I, for one, won’t. It goes against everything I believe in and grew up with. On the other hand, I won’t allow myself to live recklessly and forgo a medication that could save me from an untimely demise. Bottom line is, I don’t think anyone should have to put a price tag on their life like that.
So, what did I do? What I always do when I’m at a loss: I called my mom in Austria, who went to her doctor – free of charge or copay, of course – and asked him to write her a prescription so she could buy the EpiPen for me. The doctor has known me since I was five years old and was happy to help, as he was when my American grandmother couldn’t afford her asthma inhaler a few years ago.
My mom filled the prescription at an Austrian pharmacy and paid the full retail price of 64 euros (about $71) for a single EpiPen. If I were still insured through Austria’s government healthcare system, I would have paid the standard prescription co-pay of roughly $6.50 – that’s it. The EpiPen itself would have been fully covered by my insurance.
I won’t bore you with my thoughts on why socialized health care is a great thing – which it is. I will, however, offer the moms and dads, young adults like myself, or anyone who doesn’t have $600 lying around or can’t hold out for Imprimis’ $100 pen, some advice.
You can order EpiPens online through a Canadian pharmacy service. A two-pack runs $153.99, roughly half of what an EpiPen with Mylan’s $300 savings card would be. Should we really have to jump through all these hoops to get affordable life-saving medications? No, but it beats the alternative of ants, peanuts, or dairy literally being the death of us.
It goes without saying that multiple culprits contributed to this issue. The healthcare system is certainly flawed, pharmaceutical companies have too much control over pricing, and many healthcare consumers don’t have a clue – that all adds up to the mess we’re in right now. Other than sharing my two cents with our readers – darned if I know where to start fixing the debacle – unless it’s taking to heart what Baum said in his interview with CNN.
“When you have monopolies that are artificially created, there isn’t competition, prices go up, and you have limited access for people,” he said. “Access should be the number one government policy … right now.”
Top image: For people with severe allergies, EpiPens are both a necessity and a financial burden. Photo by Scott Ball.