Epipen 500% Price Hike: What it Might Mean to EMS Response

I have pretty severe food allergies all the way from childhood, resulting in anaphylactic reactions that, at one point, had actually gotten me intubated and landed on a vent. When I was a kid, it was cool. Great story to tell on the dodge-ball court. The pediatrician had given my mother this nifty little kit that I had to bring to school with me. Ana-kits they were called, and in it was the Epipen’s predecessor, a prefilled syringe with 0.3mg of epinephrine in it, and two diphenhydramine tablets. The theory being, if you started to have a severe allergic reaction to something, that Ana-kit would at least halt airway compromise and urticaria until the paramedics could get there. Or in my case, since it was the 70s, your mom arrived, calmly popped you into the car and brought you to the doctor’s office, where he handled the rest.

Ana-kits evolved over time, and ditched the diphenhydramine for chlorpheniramine – a more powerful cousin but still in the same family. Then, in the later 70s, came the Epipen autoinjector. It seemed medieval in its form and function. You jam it against the meat of your thigh, wait for the spring-loaded syringe to do its thing, and hold it against yourself for a few agonizing minutes while the life-saving epinephrine was dispensed. I’ve had to use it. Even the sound it makes is scary. A traumatic event in and of itself, but death of course would be far more traumatic.

Epipen users are now facing a different kind of trauma:  what once cost under $50 at most pharmacies is now carrying price tags of $450 and up. Some insurance plans won’t even cover it now and, if they do, even the copay is pricey. You can buy an Epipen over the counter at your local pharmacy, but without insurance it’s going to run you more than a luxury car payment. How and why did this happen exactly?

The answer:  big pharmaceutical business, plus no competition. A recent article in The New York Times took a hard look at the why, and tried to nail down the manufacturer’s reasoning: “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.”

Mylan, in response, pointed the finger at high-deductible insurance plans. They offer a $100 coupon for it, but with quite a few insurance carriers it still means a $400 copay for two Epipens (doctors recommend patients always have two). Past that, Mylan has been pretty silent on the hotbed issue. A $400 copay. With the first day of school already here in some states, or rapidly approaching, I can imagine that parents are scrambling to find a way to get those life-saving autoinjectors for their kids. And with only an 18-month shelf life from the time of manufacture, you can’t stockpile these devices. You must replace them.

EpiPenThe Allergy and Asthma Foundation of America, in its most recent study, estimates that 1 in 50 people suffer anaphylactic reactions. The current U.S. population, as of the January 2016 census, is 322,762,018. Let that cook for just a minute. What do folks do when anaphylaxis – a true life-threatening emergency – is imminent and they have no other way to get help? Call 911 – exactly as they should. Our calls for service are most certainly going to go up, if they haven’t already. With the rising cost of healthcare as a whole, EMS often finds itself acting as primary care provider for the poor and elderly population that cannot afford any other way.

In some ALS and BLS systems – Connecticut for example, first responders carry Epipens as part of their arsenal. One Connecticut lawmaker is furious, and taking the fight against the price hike straight to Washington, and to Mylan, the source itself. U.S. Senator Richard Blumenthal (D-Conn.) in a letter dated Monday, August 22 to Mylan CEO Heather Bresch demanded the executive answer for the price hike and come up with a plan to get the product into the hands of the consumer (EMS agencies included) by September 6. In the body of the letter he stated he that he was furious that Mylan saw fit to raise the price on a product that has neither changed nor improved in years.

He wrote, “My office has heard from first responders on this issue, with one emergency medical services (EMS) supplier offering ‘lists of EMS representatives who can show you that EpiPen prices are destroying their EMS budgets,’” he said. “In fact, first responders in other states have turned to directly injecting epinephrine using syringes, a method that is far less safe but increasingly necessary. Along with ambulances, schools in Connecticut are also required to stock epinephrine auto-injectors. The cost that Mylan’s price increases have waged not only on individual families, but on each taxpayer in Connecticut, is unacceptable.”

He offered a bulleted list of specifically targeted questions to the CEO and demanded a call to action from her. One dealt directly with the EMS impact: “First responders in Connecticut and around the country are struggling to pay for your product. Do you have financial assistance programs to help provide our first responders with the tools they need to save lives?” He’s not the only one. Lawmakers around the country are demanding a hearing in D.C. on the issue, and are calling on the Federal Trade Commission to investigate the Epipen pricehike.

What makes the sting even worse? NBC News reported just recently that Mylan CEO Heather Bresch has given herself several significant raises over the past few years, as the price of her company’s product consistently skyrocketed. In 2007, proxy filings show that she made $2,453,456 yearly; in 2015 that salary grew to $18,931,068 – a 671% increase. But so far, there seems to be no relief in sight. Between the kids going back to school, the bees still in full flight as late summer drags on, and, here in Florida, where the fire ants are marching and the stingrays are doing their own shuffle, it’s shaping up to be a long season. Let’s hope lawmakers can force Mylan’s hand and get the much-needed device back to consumers at a price they can handle.

Take care of each other out there! Be safe!

Disclaimer: The content in this article is the opinion of the writer and does not necessarily reflect the policies or opinions of US Patriot Tactical.

Leah Dallaire

Leah G. Dallaire is a highly accomplished freelance writer, editor and consultant with 28 years of experience. She has also concurrently been a paramedic for 20 years; the last 17 she spent serving the citizens of Pinellas County, Florida, which has a call volume of about 209,000 runs per year. She holds an M.A. and a B.A. in Writing & Literature from Union University. She has also just finished her first novel.
Leah Dallaire
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