Pricey EpiPens Put Pressure On Consumers

September 12, 2016
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Mater Dei School Nurse Beth Kerekes holds an EpiPen at the start of the school year. The cost of the lifesaving epinephrine injection has gone up over 400 percent since 2007. Photo by Anthony V. Cosentino

Mater Dei School Nurse Beth Kerekes holds an EpiPen at the start of the school year. The cost of the lifesaving epinephrine injection has gone up over 400 percent since 2007. Photo by Anthony V. Cosentino

By John Burton and Joseph Sapia

As parents of some students prepare their children for the return to school, they will have to pack what could be a lifesaver for them – no matter what the cost.

EpiPen is an auto-injector that provides an emergency dosage of Epinephrine in cases of severe allergic reactions and asthma attacks. These are administered when time is often of the essence, with these reactions often life-threatening.

In recent weeks, however, Mylan, the pharmaceutical company that manufactures the trademarked EpiPen dispenser, announced a colossal price increase that has left many outraged.

“It’s really a scam on the part of this company, how they’re taking advantage of people,” said Kathleen Altenburg-Largey of Middletown, a purchaser of the EpiPen.

With its increase, the price of a two-pen set is now $608.61. When Mylan acquired the product in 2007 the cost to pharmacies was about $57, according to a drug cost database compiled by Elsevier Clinical Solutions, a health care provider trade association.

Altenburg-Largey has to keep pens available for her own allergic reaction to bee stings and for her 18-year-old son, who suffers from severe food allergies. Thankfully, she explained, her health insurance has a good prescription plan. The pharmacy charged her insurance $1,391 for the pens she needed for the two of them, leaving her a $5 co-pay. “That’s insane,” she said.

“And there have been times when I didn’t have the insurance and the cost was like, astronomical,” she said, at times forcing her to make tough choices and curtailing other necessary spending.

“We only prescribe the pens for the most life-threatening allergic reactions,” noted Michael Marchetti, M.D., an emergency department attending physician at Bayshore Community Hospital, Holmdel. “It’s serious medicine. It’s not a medicine we prescribe lightly.”

But it is a medication that is getting more widely prescribed, which Marchetti attributes to more awareness and education on the part of both doctors and patients. “That’s my perception…people are becoming smarter; doctors are more comfortable.”

Marchetti had for the better part of two decades served as medical director for MONOC, the Monmouth Ocean Hospital Service Corporation, where he trained both basic lifesaving (BLS) and advanced lifesaving (ALS) technicians in how to use the EpiPens, among other training. A state law enacted a couple of years ago now allows BLS techs to use the item. Prior to the law only ALS-trained techs were allowed.

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And that led emergency services to up the number of pens each vehicle carries, creating more of a demand for them, Marchetti pointed out, suspecting that increase could be a contributor to rate hikes.

“The EpiPen buys you time,” Marchetti explained. It’s a fast-acting medication “working in seconds instead of minutes or hours,” as other treatments, like steroids. It can help reduce swelling from anaphylactic shock, which can block victims’ air ways and drop blood pressure to dangerously low levels. “Without it, many could die,” he warned.

Reuben Campos, Colts Neck, relies on the EpiPen to address his severe allergy to bee stings. Photo by Joseph Sapia

Reuben Campos, Colts Neck, relies on the EpiPen to address his severe allergy to bee stings. Photo by Joseph Sapia

Reuben Campos, a Colts Neck farmer who works on his family-owned Sugar Loaf Hill Farm, found out about six years ago he was allergic to bee stings. “I found out the hard way. I had a bad reaction to it.”

Last year while working he was stung by a bee and delayed using the medication. It was a burning, tingling sensation at first and then progressed to where he felt “awful heat, burning up. Then my throat started closing up, nausea.” He self-injected and was able to drive himself to the hospital where he was treated with steroids. “If I didn’t have the pen I don’t think I would have made it to the hospital,” he said.

The last time he bought EpiPens it cost him about $170 for a set of two, with his health insurance helping (though he needs a prescription from a specialist to be covered). But he checked with his local drug store and found it would now cost him $745.

“I really don’t have a choice,” he said, realizing, “I’ll have to save for it.”

Calls to Mylan’s U.S. corporate communications offices at its headquarters in Canonsburg, Pennsylvania, were not returned. But Heather Bresch, the company’s chief financial officer, was widely quoted in media outlets as blaming the U.S. health care system, which she said is overly burdensome and complex and incentivizes higher prices all along the supply chain, including higher co-pays and deductibles.

Whatever the cause or culprit, “People are concerned about how they’re going to cover the costs,” observed Richard Sagall, M.D. with NeedyMeds.

Sagall is a physician and president of NeedyMeds, a national not-for-profit patient assistance program in Gloucester, Massachusetts. “I can tell you the number of calls we’ve been getting about the patient assistance program has gone up since this has all began,” Sagall said, a “significant increase.”

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“We are hearing a lot of outcry. People are not happy,” with the situation, said Michael Rea, CEO of Savings Solutions, Overland Park, Kansas. Savings Solutions is a national company which helps its clients find cost-saving measures for prescriptions and other medical care. “You can jack up the price 10 times and you know people are not going to say no,” Rea said of the situation for this and other life-sustaining medication. “They’ll do anything possible to afford it,” creating a built-in demand, he explained.

With the EpiPen, “What you’re really buying is insurance,” Sagall said. Patients hope they will not need it.

The pens also have a limited shelf life, “So, they expire within a few months of getting them,” said Altenburg-Largey. “You end up throwing them out, which really adds to the cost even more. It’s a waste.”

Bresch has recently announced Mylan would be offering a discount card, which would be available to some based upon a financial needs test that also takes into consideration the patient’s insurance status. The company has also announced it’s planning to market a generic version in the foreseeable future.

“I do suggest that people shop around,” Sagall advised. He suggested consumers check out competing pharmacies for the best possible price.

There is already an alternative epinephrine auto-injector on the market that Rea suggests to clients. The cost, he said, is about $200 instead of the EpiPen $600-plus. Savings Solutions has been recommending that less expensive alternative for four years, according to Rea. “There are options available to folks,” he said.

The debate has spilled over into the political arena, too. U.S. Rep. Frank Pallone (D- NJ), whose district includes portions of the Two River area and who is the ranking Democrat on the U.S. House of Representatives’ Energy and Commerce Committee, joined other committee members in sending a letter to Bresch. The committee is seeking information from Mylan justifying the product’s 400 percent price increase since 2007. The committee is hoping to schedule Congressional hearings on the matter sometime this month.

On the legal front, this week New York State Attorney General Eric Schneiderman announced on Tuesday his office has begun an investigation into Mylan Pharmaceuticals, Inc. Schneiderman is alleging the company may have inserted anti-competitive language into sales contracts with New York public school districts. If that’s found to be the case, the Attorney General’s Office said, it could be a violation of anti-trust laws.

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