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EpiPen Price Rise Sparks Concern for Allergy Sufferers


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2016 Aug 24, 11:53am   14,076 views  60 comments

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http://well.blogs.nytimes.com/2016/08/22/epipen-price-rise-sparks-concern-for-allergy-sufferers/

A steep increase in the price of the EpiPen, a lifesaving injection device for people with severe allergies, has sparked outrage among consumers and lawmakers who worry that parents won’t be able to afford the pens for children heading back to school.

With a quick stab to the thigh, the EpiPen dispenses epinephrine, a drug that reverses swelling, closing of the airways and other symptoms of a severe allergic reaction to bee stings, peanuts or other allergens.

Mylan, the pharmaceutical company, acquired the decades-old product in 2007, when pharmacies paid less than $100 for a two-pen set, and has since been steadily raising the wholesale price. In 2009, a pharmacy paid $103.50 for a set. By July 2013 the price was up to $264.50, and it rose 75 percent to $461 by last May. This May the price spiked again to $608.61, according to data provided by Elsevier Clinical Solutions’ Gold Standard Drug Database.

Doctors advise allergic patients to carry two EpiPens with them at all times in case an extra dose is needed to quell a severe reaction. Most parents buy multiple EpiPens for home, in the car and school and may replace them annually, depending on the expiration date.

Mylan has declined to comment on the price hike, issuing a statement pointing the finger at high-deductible health plans that require consumers to pay much more out of pocket for many drugs. The company said a $100 coupon they offer for the product means most people don’t pay anything for the pens.

But how the price hike affects consumers varies widely, depending on the prices charged by their local pharmacy and the details of their insurance plan. People without insurance or with high-deductible insurance plans can’t always use the coupon and are paying about $640 a set, said Michael Rea, the chief executive of Rx Savings Solutions in Overland Park, Kan. Other patients say that even with good insurance, their copayments are as much as four times higher than in the past.

Naomi Shulman of Northampton, Mass., has a 12-year-old daughter who is allergic to cashews and keeps EpiPens at home and school. Last year, Ms. Shulman’s out-of-pocket copayment for an EpiPen two-pack was $100. But because EpiPens may expire after a year, Ms. Shulman had to buy another two-pack to send along to her daughter’s camp this summer. Her cost for the same two pens was $400.

“I called the insurance company and asked why it was so high and was told that, actually, it’s $700 total, and my co-pay is $400,” she said.

Lauren Barr of Clark, N.J., said her copayment on EpiPens has risen from $141 to $245 in a year, and she will spend $735 this year for a supply of three EpiPen sets. Her 6-year-old daughter Leah is allergic to rice, tree nuts and mushrooms.

“The price of EpiPens has been getting progressively worse over the years, but now it is just obscene,” Ms. Barr said.

The price hike has caught the attention of Washington lawmakers. Senator Amy Klobuchar, Democrat of Minnesota, who has a daughter who carries an EpiPen, has called on the Senate Judiciary Committee and the Federal Trade Commission to review whether the price hikes violate any anti-competition rules. Last year, the drug maker Sanofi recalled a competing product, Auvi-Q, because it may not have been delivering the correct amount of epinephrine, leaving the EpiPen as the primary emergency treatment for severe allergic reactions.

“This is a mainstream product that people carry, and it’s getting harder and harder for people to afford it,” said Senator Klobuchar. “It’s just another example of what we keep seeing, outrageous price increases when a monopoly situation ends up in a company’s lap.”

Senator Chuck Grassley of Iowa called on Mylan to explain the price hikes, noting that they impose a burden on both parents and school districts, who often keep supplies of the pen at the ready.

A petition to Congress protesting the price increase, called “Stop the EpiPen Price Gouging,” has emerged on social media. It has collected more than 48,000 signatures.

In April, a pharmacist told Sarah Brown of Boulder, Colo., that her copayment on an EpiPen two-pack would be $585, even with a $100 coupon from Mylan. She said she had no choice but to take her chances and hold on to her expired EpiPens instead. “It was a gamble,” she said.

#corruption #pricegouging #mylan

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1   zzyzzx   2016 Aug 24, 11:54am  

zzyzzx says

Mylan has declined to comment on the price hike, issuing a statement pointing the finger at high-deductible health plans that require consumers to pay much more out of pocket for many drugs. The company said a $100 coupon they offer for the product means most people don’t pay anything for the pens.

How does this make ANY sense when the price goes from $100 to $608???

2   zzyzzx   2016 Aug 24, 11:56am  

Article fails to mention how the government is currently blocking the generic equivalent that Teva wants to make.

3   NuttBoxer   2016 Aug 24, 12:34pm  

Prevention, as usual, is also ignored. My daughter has never had an ear infection, asthma, or allergies to anything. She is the only one in our family who is like this. The main reason I can point to is we have drastically changed our diet to eliminate chemicals, and increase fruits/veggies, and use natural cleaning products. Having an insurance policy in case of emergency is great, but being in a position to prevent the emergency from ever occurring is better.

4   Tenpoundbass   2016 Aug 24, 2:42pm  

We're the mother fuckers paying $1,200 for Toilet Seats and $3,000 screw drivers.
Who said government would be cheaper if you just send the bill to the tax payer directly?

5   RC2006   2016 Aug 24, 3:17pm  

I can only hope a bitch like this and her entire family die. People like this are a cancer. Tax payers that are funding government healthcare that is covering this 100% are really getting fucked over along with people with deductibles.

6   Dan8267   2016 Aug 24, 5:20pm  

Capitalism, using your children's lives to gouge you for every nickle. Tell me again how capitalism is an efficient system for allocating resources.

Just think about it. The capitalist model is to set the price that brings in the maximum profit, which necessarily entails that some people won't be able to afford the product, which in this case means some children dying. If no child dies, then the price is set too low. That's capitalism.

7   zzyzzx   2016 Aug 24, 5:49pm  

Dan8267 says

Tell me again how capitalism is an efficient system for allocating resources.

Exactly how is government preventing generics from entering the market capitalism?

8   Heraclitusstudent   2016 Aug 24, 5:59pm  

Dan8267 says

Capitalism, using your children's lives to gouge you for every nickle. Tell me again how capitalism is an efficient system for allocating resources.

It's not capitalism. Capitalism assumes there is competition.
This is a deliberately organized situation.
The problem is government corruption.

9   turtledove   2016 Aug 24, 6:29pm  

My favorite is when they repackage and then it becomes new again. Gonal-f has been doing that for about 30 years.

10   zzyzzx   2016 Aug 24, 7:42pm  

I wonder if it's just the Epipen that's been price jacked or epinephrine itself has been priced jacked. I mean, if the drug itself is still cheap, why couldn't I just get a vial of that to keep around and fill the needle myself? I've mean giving my current grey and white cat insulin shots 2X daily for years, and I'm sure I could DIY.

I see this for $40:
http://www.emswebstore.com/pharmaceuticals/prescription/epinephrine-1-1000-30ml.html

11   neplusultra57   2016 Aug 24, 7:47pm  

Heraclitusstudent says

It's not capitalism. Capitalism assumes there is competition.

This is a deliberately organized situation.

The problem is government corruption.

Capitalism as such assumes competition. Capitalism in situ always corrupts competition wherever it can. That government aides this is incidental to corrupt capitalism. Stating the "problem" so simply is simple-minded.

12   zzyzzx   2016 Aug 24, 7:54pm  

Wouldn't an OTC racepinephrine inhaler work for allergies as a cheap alternative?

13   zzyzzx   2016 Aug 24, 8:06pm  

Or should I just stock some Bronkaid? Doesn't that contain epinephrine?

14   turtledove   2016 Aug 24, 9:18pm  

Here they are from an online Canadian pharmacy. $115 for the pen.

http://www.canadapharmacyonline.com/DrugInfo.aspx?name=EpiPen+Auto+Injector-+Epi+Pen6337

16   Dan8267   2016 Aug 24, 10:53pm  

Heraclitusstudent says

Capitalism assumes there is competition.

Actually, no it doesn't. That's a myth. The definition of capitalism has nothing to do with competition or free markets. The one and only defining characteristic of capitalism is private ownership of the means of production and distribution.

Capitalism actually works to prevent competition and free markets as those things lower profit margins.

17   Dan8267   2016 Aug 24, 10:56pm  

turtledove says

Here they are from an online Canadian pharmacy. $115 for the pen.

Technically illegal due to capitalists buying senators.

http://www.elderlawanswers.com/buying-prescription-drugs-from-canada-legal-or-illegal-1204

A 30 tablet supply of the drug Abilify costs $199.70 from an online Canadian drugstore, but $711.83 if ordered at Walgreens. One 10 capsule dose of Tamiflu sells for $112.20 in the U.S. and less than $50 in Canada. (Note: these are 2013 prices.)

But is it legal to buy medications from Canadian pharmacies? The answer is, technically no, but U.S. officials are allowing it to happen.

Under the Prescription Drug Marketing Act of 1987, it is illegal for anyone other than the original manufacturer to bring prescription drugs into the country. However, federal officials have decided to exercise "enforcement discretion" in dealing with prescription drugs brought across the border, provided the drugs are not narcotics or other controlled substances. This means that as long as a person brings back no more than a three-month supply for personal use, border officials generally look the other way, Thomas McGinnis, director of pharmacy affairs for the U.S. Food and Drug Administration (FDA), told the Milwaukee Journal Sentinel in March 2001. Patients generally may order refills in amounts up to a three-month supply without interference.

What about ordering over the Internet? Prescription drugs cannot be legally mailed into the United States by foreign "e-pharmacies." But here again officials are employing "enforcement discretion," preferring to use limited resources to crack down on large commercial drug supplies and narcotics, not prescription-drug shipments for personal consumption. Thus, customs officials allow the companies to mail up to 90-day supplies of medications.

18   Dan8267   2016 Aug 24, 10:57pm  

zzyzzx says

Exactly how is government preventing generics from entering the market capitalism?

Patent laws written by big corporations.

19   bob2356   2016 Aug 25, 3:56am  

Ironman says

The economist looks for competitors in cases like this. A firm cannot just willy-nilly raise their prices without a competing firm leaping in to give consumers what they want at a lower price. As it turns out, Mylan has a great friend who keeps would-be competitors out of the market, or at least makes it so difficult for them that they eventually go out of business. That friend is the FDA.

As usual you don't have a clue, but manage to find an article written by someone equally clueless. The epi pen is under patent. As tdove stated pharma continually tweaks (calling it research spending which you are so quick to defend) patented drugs and devices (the epi pen is covered under a patent for it's needle protector) to extend their patents on and on and on. The epi pen was first patented in the early 80's and somehow will be protected until 2025. Nice.

It seems you are not aware competing firms can't just leap in to give consumers what they want at a cheaper price if the product is protected by a patent. Neither is the clown who wrote the article you are so proud of.

Teva won a lawsuit against the epi pen patent in 2012. Their version of the epi pen failed trials and was rejected by the fda. Teva is modifying their pen and expect to try again next year. The idea the fda rejected Teva's epi pen to protect protect Mylen profits is absurd. But you sucked it up, which is to be expected. But then again if the fda had approved the pen and it had failed in the field you would have screamed the fda doesn't look closely enough.

Poor Teva being put out of business by the fda. They only have 15% YOY revenue increase for 2016 up to 22.4 billion with net profit margin up from 13% to 25%. My heart bleeds that they are being picked on by the fda..

20   indigenous   2016 Aug 25, 5:44am  

That settles it then the FDA is beyond reproach.

21   Y   2016 Aug 25, 6:17am  

As with any product the lower quantities you manufacture the more it costs. Savings is realized with mass production.
The blame for this can be directly traced to digital signatures, making the pen as useless as...
fuck, it's too early for this shit...

zzyzzx says

EpiPen Price Rise

23   Shaman   2016 Aug 25, 6:28am  

bob2356 says

Poor Teva being put out of business by the fda. They only have 15% YOY revenue increase for 2016 up to 22.4 billion with net profit margin up from 13% to 25%. My heart bleeds that they are being picked on by the fda..

Why are you so partisan, bob? This is a clear-cut case of capitalist gouging of the consumer, made possible by government cronyism and corruption.
But you defend it? At this point you can't even call yourself a liberal, just a Democrat team-player, along for the ride as they go into Nero territory.

24   mell   2016 Aug 25, 8:45am  

zzyzzx says

Article fails to mention how the government is currently blocking the generic equivalent that Teva wants to make.

I'm much long ATRS (may have mentioned that before) which in partnership with TEVA supplies the generic version. Good publicity for the stock. Still a good time to jump in into this turnaround story.

Ironman says

bob2356 says

Their version of the epi pen failed trials and was rejected by the fda. Teva is modifying their pen and expect to try again next year.

Oh Bullshit Bobby. Do you really think with today's technology it is so difficult to design a delivery device that works?

Agreed, The generic version should have been approved, but there's lots of politics and protection of major drug makers. Same thing happened for very long with Shire who was protected from Chelsea's doxidropa which eventually got approved after giving Shire many more years of $$$ for their inferior drug. The "concerns" some of the FDA panel members came up with were astounding to put it mildly ;) Too much politics and crony protection everywhere in politics these days.

http://nypost.com/2016/08/24/ceo-who-gouged-price-of-epipen-is-daughter-of-democrat-senator/

25   turtledove   2016 Aug 25, 8:52am  

Dan8267 says

Technically illegal due to capitalists buying senators

Humm... My IVF patients do it all the time. I just provide the prescription. What they do with it afterward is their business. But most of them are doing it because they can get their meds for $2,000 vs $6,000. For some of these patients it's the difference between being able to afford to do the cycle, at all. I find it ironic that the parts of IVF that have gone up are the facility portion (anesthesia) and the drug portion. The rest has remained stable for 30 years! Interesting how it's the part that is NOT ever covered by insurance where the prices stayed the same (even went down on certain things).

26   anonymous   2016 Aug 25, 9:15am  

Interesting how it's the part that is NOT ever covered by insurance where the prices stayed the same (even went down on certain things).

------------

Not sure interesting is the word you were looking for here

27   MisdemeanorRebel   2016 Aug 25, 9:42am  

Dan8267 says

Patent laws written by big corporations.

Yep. And just wait until TPP passes.

The TPP member states have surrendered their sovereign right to define ‘patentability’ criteria. Not only have they have surrendered their right, they have agreed to grant patents for:

a) new uses of a known product;
b) new methods of using a known product, or;
c) new processes of using a known product.

This would lead to the “evergreening” of patents and result in an average extension of monopoly by at least five years. Some can stretch it beyond five years, as was done by Novartis AG for Gleevec (imatinib). This would encourage innovators to go for low-hanging fruits at the cost of more difficult-to-succeed efforts. Generics will slow down and patients will have to wait longer for affordable treatments.


http://www.ip-watch.org/2015/12/02/impact-of-the-tpp-on-the-pharma-industry/

28   Dan8267   2016 Aug 25, 10:24am  

turtledove says

What they do with it afterward is their business.

We live in a global economy. I have to compete with cheap third world labor for my talents. Companies should have to compete with foreign competition for their products. Either you should not be able to outsource IT or everyone should be able to outsource pharmaceuticals. It is utter hypocrisy to allow companies to buy labor from any market but not allow consumers to buy goods and services from more than one market, and one that is severely restricted.

29   Dan8267   2016 Aug 25, 10:26am  

thunderlips11 says

Yep. And just wait until TPP passes.

Another reason to vote against Hillary. She's all for the TPP except when she thinks it's unpopular and says she's against it, but you know she's really for it.

http://www.politifact.com/truth-o-meter/statements/2015/oct/13/hillary-clinton/what-hillary-clinton-really-said-about-tpp-and-gol/

30   MisdemeanorRebel   2016 Aug 25, 10:27am  

Dan8267 says

It is utter hypocrisy to allow companies to buy labor from any market but not allow consumers to buy goods and services from more than one market, and one that is severely restricted.

Surprise! Treaties written by big Multinationals favor themselves. The ideology is only the pastiche; money is the object.

It's why you have companies that hate paid sick days or holidays, letting their largely immigrant workforce take the day off to protest immigration enforcement.

On the minimum wage, healthcare, holidays, sick leave, safety, outsourcing, etc. corporate America is mostly dyed in the wool greedbags. But we're supposed to believe when it comes to Immigration and Insourcing, they honestly have the best interests of everybody in mind, and if you don't agree you must be a racist.

31   turtledove   2016 Aug 25, 10:29am  

Dan8267 says

and one that is severely restricted.

No doubt under the guise of public safety.

Though in that regard, I should mention that it's estimated that half of the world's drugs are adulterated (in other words, watered down for profit). The FDA guards against that. So you do take your chances when you order stuff from certain countries. But I wouldn't consider Canada to be one of those countries...

32   missing   2016 Aug 25, 10:36am  

turtledove says

Humm... My IVF patients do it all the time. I just provide the prescription.

Are there restrictions for using prescriptions abroad, and from abroad? My mother was visiting some time ago and wrote perscription for antibiotics for herself (she is a doctor). The pharmacy refused to honor it.

33   turtledove   2016 Aug 25, 10:47am  

FP says

Are there restrictions for using prescriptions abroad, and from abroad? My mother was visiting some time ago and wrote perscription for antibiotics for herself (she is a doctor). The pharmacy refused to honor it.

Depends. Here you need a valid prescription from a doctor who is licensed in the US. My husband has licenses in several countries, so it doesn't really come up as a problem for him. He can write here, of course, the UK, Ireland... and then the UK registry has reciprocity with other countries... So, Dubai recognizes the UK license, HK used to... that's probably changed, though.

I'm not sure how my patients get away with filling their prescriptions through the Canadian pharmacy. The Canadian pharmacy must have a US office that they run US generated scripts through. Because I've never had a patient tell me she had to get a duplicate script from a Canadian doctor... and I know that Canada doesn't accept scripts written by doctors who don't hold a Canadian license. But, it works. If the shipment were to get stuck in customs, the DEA just cares that you have a US prescription, so patients are covered on that end. If it got stuck on the other side of customs, you might have a problem. Not a huge problem... You'd just need to find a local doc to rewrite the prescription. That wouldn't be a big deal with fertility medications... Now if you're talking narcotics, that would be a much more serious issue.

34   Dan8267   2016 Aug 25, 10:59am  

thunderlips11 says

a) new uses of a known product;

b) new methods of using a known product, or;

c) new processes of using a known product.

All of which go entirely against the alleged purpose of patents, to encourage innovation. All of these things stifle innovation.

If I discover a way of using smartphones to cure cancer, why would I spend my time and effort developing a cancer curing app if Apple gets all the profits because I'm using their product in a new way? Capitalism is incompatible with free markets and innovation. Those who own the means of production and distribution do not want other people inventing new means of production and distribution for doing so circumvents their control and their ability to siphon all wealth creation.

35   bob2356   2016 Aug 25, 2:23pm  

Quigley says

bob2356 says

Poor Teva being put out of business by the fda. They only have 15% YOY revenue increase for 2016 up to 22.4 billion with net profit margin up from 13% to 25%. My heart bleeds that they are being picked on by the fda..

Why are you so partisan, bob? This is a clear-cut case of capitalist gouging of the consumer, made possible by government cronyism and corruption.

But you defend it? At this point you can't even call yourself a liberal, just a Democrat team-player, along for the ride as they go into Nero territory.

What is partisan? Where in the world do you see a defence of anything? Just pointing out that as usual iron brain has his head up his ass. The problem with epi pens is the patent system, not the fda despite the usual knee jerk bullshit of the terminally and wilfully uninformed who have spent so many years rattling around the right wing echo chamber that they no longer have even the faintest grasp of reality. How exactly do you see that as liberal or democratic team player? I was a registered republican for 30 years until bush rove, and darth cheney destroyed the party. No one I know has ever considered me liberal. But I'm not batshit crazy right wing nut either, so to the low wattage posters who are batshit crazy right wing nuts anyone left of hitler is a liberal.

Ironman says

Oh Bullshit Bobby. Do you really think with today's technology it is so difficult to design a delivery device that works?

I don't know. Teva accepted the fda's findings and is redesigning. Want to fill us in on how you know more than the manufacturer about it? Totally lacking in your tin foil hat scenario is any reason whatsoever that some gs scale fda employee would care which company makes the money.

36   bob2356   2016 Aug 25, 2:41pm  

FP says

turtledove says

Humm... My IVF patients do it all the time. I just provide the prescription.

Are there restrictions for using prescriptions abroad, and from abroad? My mother was visiting some time ago and wrote perscription for antibiotics for herself (she is a doctor). The pharmacy refused to honor it.

You need a dea number to write scripts for controlled substances in the US. Non controlled just needs a us medical lic in theory, but many states require a dea number for all scripts. Some states don't fill out of state scripts in certain circumstances . Texas requires a script on a texas script pad for controlled as an example.

Prescriptions abroad are country by country.

37   turtledove   2016 Aug 25, 6:08pm  

bob2356 says

You need a dea number to write scripts

And you need a license to have a dea number. Seriously, you don't have to split hairs on every little thing, do you? Obviously, we have both a license and a dea number.... and an NPI number and a tax ID number... But by saying licensed, we were referring to the ability to prescribe in the US, in general. We assumed that the person had a dea number or obviously he/she wouldn't be prescribing anywhere.

38   indigenous   2016 Aug 25, 6:53pm  

What is you all's take on this?

39   MMR   2016 Aug 25, 7:16pm  

If you can get your hands on vial and know how to dose it, you canIronman says

It never stops you from proving what an idiot you are.

While not always right (claiming that primary care doctors would not have patients if they don't round on their patients in hospital)....he's not an idiot...

He feigns stupidity to start arguments

40   bob2356   2016 Aug 25, 7:44pm  

turtledove says

And you need a license to have a dea number. Seriously, you don't have to split hairs on every little thing, do you?

Read more carefully. I was responding to the comment about prescriptions abroad and from abroad, not to you.

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