A few weeks ago, I talked to STAT News's Ike Swetlitz about the soaring price of EpiPens. (Both of my sons have food allergies and need to keep epinephrine on hand at all times.) In the intervening weeks, the issue of EpiPen prices exploded onto the national scene with Members of Congress calling for hearings and Heather Bresch, the CEO of Mylan, which produces the EpiPen, coming under considerable fire. I reached out to Swetlitz again to talk through the rapidly-changing landscape and what to expect next. Our conversation, conducted via email and edited only for grammar, is below.
FIX: Why, all of a sudden, did the rising price of EpiPens become such a big national issue? Was there a catalyst or just lots of little sparks?
Swetlitz: People have known about the rising price of EpiPens for a while -- as I reported last month, Washington state EMS providers starting dropping EpiPens in favor of regular syringes in 2013 because of the rising costs. But over the past year, we've seen increased scrutiny on drug prices, and EpiPens are so well-known that it's easy for them to attract attention. Parents of children with allergies have been aggressively advocating for lower prices, and it doesn't hurt that multiple members of Congress are making this a priority.
I think that the public discussion around EpiPens raises a lot of important questions about drug pricing that resonate with people. If so many people in our society have allergies, does it make sense for us to have a pricing system that either requires them to buy low-deductible insurance plans, or automatically charges them more for the same peace of mind that everyone else has? And what are you really paying for when you buy an EpiPen? Are we paying for the drug? Are we paying for the functionality? Are we paying for the assurance that we'll be ok? And who deserves our money?
FIX: Mylan has made several moves to try to beat back the bad PR they are receiving. Can you explain them – and whether they will actually work to lower costs for EpiPens?
Swetlitz: Mylan took two concrete steps . First, the increased the value of a coupon on EpiPens that they had been offering for $100 to $300. Only patients who are commercially insured can take advantage of this coupon. Mylan declined to tell me how many people actually use the savings card. For some patients, this could be a huge help. But they need to know about the program, and they need to be able to access the coupon. I spoke with one woman who was able to save $200 with the coupons, but only because she had a smartphone with her and the pharmacist was able to pull up the coupon on her phone.
They also increased eligibility for their "patient assistance program," which allows uninsured individuals making up to 400 percent of the federal poverty line to receive free EpiPens (previously, the limit was at 200 percent). Patients need to fill out a form, which has to get signed by their doctor.
Both of these put the burden on the patient -- they need to know about the program, and they need to have the resources to access and take advantage of them.
And as your Wonkblog points out, none of these measures lower the price that pharmacies or insurers pay for the EpiPens, so the high list price of the EpiPen might be passed on to the consumer in other ways.
FIX: Heather Bresch is suddenly very much under fire. Aside from that she’s Joe Manchin’s daughter what do we know about her?
FIX: Several members of Congress are calling for hearing on EpiPen pricing. How likely is this to happen? And does Mylan have any plan on how to keep those hearings from being a PR disaster?
Swetlitz: I'm curious about how this meeting will go. Bresch said on CNBC yesterday morning that she's called the members of Congress and is eager to work with them. My STAT colleague in DC, Dylan Scott, says that a hearing is likely, given the high profile of some of the lawmakers who have taken up this issue.
Mylan's in a tough position -- they are trying to justify their practices and also put their business in the context of the larger pharmaceutical industry. Bresch said she wants everyone at the table in the conversation about how to fix drug prices. I have no doubt that Mylan, now that they're part of the public conversation, will be part of the process. One of my big questions now is -- how will the rest of the industry respond?
FIX: The big problem has been that there are no competitors to Mylan’s EpiPen. Does all of this controversy make it more or less likely a true alternative to the Epipen will emerge?
Swetlitz: The attention on EpiPens is certainly making this question more urgent. So far, we haven't heard any announcement that companies selling auto-injectors in different countries are looking at the U.S. market -- but even if they were, it's an open question as to whether or not they'd be able to offer a significantly lower price.
It takes time to bring any medical device to the market -- and, as Bresch said, it's the market that's broken. An alternative to "the EpiPen" may not be so much about an alternative device for auto-injecting epinephrine as it might be about an alternative way of getting medicine to patients, period.