Update, 8/20:  Minnesota Sen. Amy Klobuchar (D) is calling for congressional hearings into the soaring prices for EpiPens. Here's what Klobuchar said in announcing her push for hearings: "This outrageous increase in the price of EpiPens is occurring at the same time that Mylan Pharmaceutical is exploiting a monopoly market advantage that has fallen into its lap. Patients all over the U.S. rely on these products, including my own daughter. Not only should the Judiciary Committee hold a hearing, the Federal Trade Commission should investigate these price increases immediately. The Commission should also report to Congress on why these outrageous price increases have become common and propose solutions that will better protect consumers within 90 days. "

 

In light of Klobuchar's decision, I am re-posting my interview with Ike Swetlitz of STAT News regarding the rising EpiPen prices. Sidenote: My sons have severe food allergies. They need to keep EpiPens with them at all times.

FIX: Epipen prices have been soaring in the last few years. Why?

Swetlitz: That’s the billion-dollar question. Literally.

Pharmaceutical prices are difficult to quantify, but one useful metric is the “wholesale acquisition cost,” which measures how much the manufacturer -- in this case, Mylan -- sells the drug to wholesalers [for]. Adjusting for inflation, that price has risen 450 percent since 2004. EpiPens are only available in two-packs, and each pack lists for about $600.

Some blame the price increase on Mylan’s near-monopoly in the epinephrine auto-injector market -- in 2015, EpiPens made up over 87 percent of all epinephrine auto-injectors prescribed in the US, according to data from IMS Health. Mylan itself is tight-lipped about the cost increase, saying only that it “has changed over time to better reflect the multiple, important product features and the value the product provides.”

Some patients are seeing this $600 price at the register. But the price isn’t nearly as high in other countries. One woman told me she purchased EpiPens from an online Canadian pharmacy for half the cost in the US.

FIX: Why is no one challenging Mylan for supremacy – or at least an equal share – in the EpiPen market?

Swetlitz: Others have been trying. Sanofi marketed the Auvi-Q, a similar product, up until last fall, when it was recalled -- and even when it was on the market, it never made up more than 10 percent of auto-injector prescriptions, according to IMS Health. Teva Pharmaceuticals is trying to get a generic EpiPen out of the factory, but their most recent application was rejected by the FDA.

EpiPen has incredible brand recognition -- it’s like “kleenex” or “xerox.” There are cheaper alternatives, but they have a small market share, and people tell me that they trust the EpiPen brand. If they can afford it, they prefer to shell out a few extra hundred bucks for the real thing. 

Mylan has had a lobbying presence in dozens of states, advocating for laws that would increase the availability of epinephrine auto-injectors. They’ve got EpiPens in Disneyland. Even I catch myself saying “EpiPen” when I really mean “epinephrine auto-injector” -- maybe it’s just a mouthful.

FIX: My insurance company told me that EpiPens weren’t covered because they weren’t an absolute necessity. But, one of my sons has anaphylaxis.  Is this a common response?

Swetlitz: People have different opinions on whose responsibility it is to have EpiPens on hand. In a school, should every student with allergies carry an EpiPen on their person and have one stocked in the nurse’s office? That’s a lot of EpiPens.

Parents who spoke with me talked more about high deductibles than insurance companies not wanting to cover EpiPens. The deductible is the amount of money that you’re responsible for paying before the insurance kicks in, and that amount has been on the rise. So people with high-deductible plans might be responsible for paying the higher cost, while people with low-deductible plans might not notice it.

FIX: Where do we go from here? Will paying hundreds or even thousands of dollars for EpiPens be the new normal?

Swetlitz: People with allergies hope not. Some are choosing to carry around regular syringes instead of the pricy auto-injectors, but nobody thinks this is ideal, and doctors warn it is less safe.

The increasing price of EpiPens is also motivating other companies to step up their game. A Boston startup is designing a smaller auto-injector they hope to have before the FDA in 2 years. A Minnesota allergy doctor is working on a keychain-sized alternative.