The EpiPen is an auto-injector that delivers epinephrine, more commonly known as adrenaline, a hormone that can help to relax muscles. It can open the airways, and reduce swelling during a severe allergic reaction, before a patient can get to the hospital.
The price of an EpiPen standard two-pack has gradually grown to about $600. The same two-pack cost only about $100 in 2009.
Meanwhile, epinephrine, which can be purchased alone, costs just a few dollars. The EpiPen, manufactured by the pharmaceutical company Mylan, offers a portable way to administer doses. “Some patients and physicians are resorting to buying epinephrine ampoules and filling their own syringes,” said Dr. Thomas Casale, a professor of medicine at the University of South Florida and executive vice president of the American Academy of Allergy, Asthma, and Immunology (AAAAI).
Many adults and families of children with severe allergies are facing sticker shock when they pay for their EpiPens, especially amid back-to-school season.
Theresa Ray, a 30-year-old mother in Cincinnati, was surprised to find that purchasing two EpiPen two-packs for her 6-year-old son would have cost her family about $1,300, she said. Her son was diagnosed with food allergies five years ago.
“When we first bought them (about five years ago), it was around $100 or $150 for a twinpack, and at that time I remember thinking, ‘Wow, that’s kind of expensive.’ Then, the next year, I found out they expired and we have to get them every year. They were more expensive, but by that time, only a couple hundred dollars,” Ray said.
“Last year, we spent around $650 for a twinpack and this year, same thing,” she said. “It was funny, I told my husband, ‘I wonder why no one’s talking about this. It’s really weird no one’s talking about EpiPens.’ … And then, I saw a news article on Facebook about it.”
‘There’s no other option’
For patients who may not be able to afford EpiPens, there are limited alternatives. Another epinephrine auto-injector, Auvi-Q, left the market last year after a recall.
On the market, there is Adrenaclick, a generic medication that offers an emergency injection of epinephrine, according to Consumer Reports. It uses a different technology, but administers the same medicine for around $200.
Are there any other options? “The ER,” Levin said. “You know, if you can call an ambulance. But when my airways are blocked, I can’t talk. So, there’s no other option.”
The AAAAI has expressed concern about the rising cost of epinephrine auto-injectors and advocates for more affordable medications for all diseases.
“Unfortunately, the shelf life of epinephrine is not very long and the need to refill prescriptions on an annual basis can result in a financial burden for patients,” Casale said.
“As a result, some patients are carrying epinephrine auto injectors that are expired because they cannot afford to refill a prescription,” he added. “Others, when they find out the price of an epinephrine auto injector, failed to fill their prescription.”
Policymakers weigh in
Minnesota Sen. Amy Klobuchar has called on the Senate Judiciary Committee to hold a hearing to investigate the rising price of EpiPens.
“Patients all over the United States 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,” Klobuchar, a Democrat, said in a written statement that was released on Saturday. “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.”
As the cost of EpiPens has been gradually rising, so has the number of patients in high-deductible health plans — alas, the impact of the cost on patients seems to be a problem that’s two-fold, said Dr. Purvi Parikh, an allergist and immunologist at NYU Langone Medical Center and an allergist with the Allergy & Asthma Network.
“While the price is increasing, the other issue now is that the health insurance plans have now put more and more responsibility on the patient,” said Parikh, who also serves as Levin’s doctor.
“It’s definitely unfortunate because it’s a necessary lifesaving medication. It’s not really a luxury,” Parikh said. “It’s a single-use medication and you need it available everywhere you go, so often our patients will have multiple sets of EpiPens at home, school, work. So it’s a huge cost on the patient.
“Not only have I seen it save lives, but I’ve seen the opposite happen, of when an EpiPen wasn’t available and both children and adults passed away.”
EpiPen manufacturer opens up
A spokeswoman for Mylan emailed a written statement from the company to CNN. In the statement, company officials indicated that they know more is needed to help patients with high-deductible insurance plans.
“With changes in the healthcare insurance landscape, an increasing number of people and families are enrolled in high-deductible health plans, and deductible amounts continue to rise. This shift has presented new challenges for consumers, and they are bearing more of the cost. This change to the industry is not an easy challenge to address, but we recognize the need and are committed to working with customers and payors to find solutions to meet the needs of the patients and families we serve,” according to the company’s statement.
Levin, the patient in New York, said that her EpiPen costs are partly covered by insurance, but she has to first pay a separate deductible under the category of injectables before she can purchase her EpiPens at the discounted insurance price.
“Five years ago, the deductible was only $100, but as the price increased, so did the deductible. So every new year, I always have to anticipate and pay the dreaded cost,” she said.
Mylan offers a My EpiPen Savings Card to help consumers with cost. Last year, nearly 80% of commercially insured patients used the card to receive the device for free, according to Mylan. The company also has distributed more than 700,000 free EpiPens to schools nationwide.
Additionally, “there are some coupons available, which help lower the cost to patients, but there still is a considerable copay for most patients,” said Casale, the AAAAI executive vice president. “Although the cost of epinephrine auto injectors has risen considerably, they are lifesaving and patients should do whatever they can to secure them.”
Meanwhile, Kesselheim and his colleagues suggested short-term strategies to reducing high drug prices in their paper.
“We need to re-examine the market exclusivities provided by the government to manufacturers to ensure that they adequately protect innovative products without similarly applying to less innovative treatments that add cost without adding value,” Kesselheim said. “More patients and physicians need to talk about the costs of medications with each other — and express concern to their legislators — so that evidence-based lower-cost alternatives can be found, if possible.”