For most parents, back-to-school season means searching for this year’s trendy first-day outfit, stocking up on 3-ring binders, and making sure that summer homework is finished. When it comes to parents of kids with severe allergies, however, there’s an extra task on that list: Re-stocking their EpiPen prescription before their children enter a world where a lethal peanut-butter-and-jelly sandwich could be lurking a cafeteria table away.
“Make sure your child always has an EpiPen(R) Auto-Injector within reach,” reads item number 2 on the “Back To School Homework for parents” webpage hosted by the EpiPen brand owner, pharmaceutical company Mylan.
Last year, about 3.6 million prescriptions were written for EpiPens, which expire each year and need to be replaced.
But Mylan has priced this life-saving medication, which can keep airways open during severe allergic reactions, far out of reach for many families. Over the past nine years, since Mylan bought the rights to the EpiPen, the price for the easy-to-use injectors has quintupled — increasing about 450 percent, from around $50 for one injector to $600 for a pack of two.
The only way the device can be purchased is in packs of two — a move made after an FDA recommendation that allergy sufferers carry two doses just in case. Selling EpiPens in packs of two, however, means that if one is lost or used, to replace it, people must buy an extra (essentially doubling their cost) they may not need. The actual dose of the hormone epinephrine (also known as adrenaline) delivered by the device costs approximately $1.
For people with no insurance, or people on one of the increasingly popular high-deductible insurance plans, the entire cost of the $600 device must be borne out of pocket. Other insurance plans may bring the cost down by a few hundred dollars , but that still leaves people paying hundreds more for the medication than they did just a few years before.
And although Mylan offers a so-called “$0 co-copay” rebate to consumers, it maxes out at $100 dollars — meaning that if insurance plans pass along the full cost of the device, consumers remain on the hook for hundreds of dollars.
For Mylan, the strategy appears to be paying off. The medication is a cash-cow for the company: According to Bloomberg Business, EpiPens provide about 40 percent of Mylan’s operating profits, accounting for billions of dollars.
Mylan insists that it has also improved the technology (though it’s unclear exactly how) and put tireless effort into “advocating for increased anaphylaxis awareness, preparedness, and access to treatment.”
A central tenet of this campaign has been marketing EpiPens to parents by emphasizing the dangers a severe allergic reaction can pose to their children, and making sure that EpiPens are a go-to medication stocked in public places like schools. The company is piggybacking off a recent legislative push for easily-accessible allergy medication, spurred after a 7-year old died in Virginia following a severe peanut reaction. Schools and public places can get the device under “entity prescriptions,” where the medication is prescribed to the place instead of the person. Now, nearly every state recommends or requires that schools have an epinephrine injector on hand.
While easy access to an EpiPen or similar epinephrine auto-injector can indeed mean the difference between life and death, increased awareness isn’t much help if families and emergency medical personnel can’t afford the medication — and with a near-monopoly on the market, Mylan has the power to price EpiPens as the company wishes.
Like Kleenex or Q-tips, the brand has become nearly eponymous with the object. EpiPen prescriptions account for the vast majority of prescriptions for epinephrine— 85 percent in the first quarter of 2015, a number that has likely increased as Mylan’s dominance of the market has increased. There is virtually no alternative: EpiPen’s one major competitor, Auvi-Q, was pulled from the market in October 2015 due to a malfunction that sometimes delivered a suboptimal dose of medication, and the FDA rejected a bid from Teva Pharmaceuticals to produce a generic version.
Some Americans struggling with serious allergies, unable to afford the medication, are turning to risky alternatives: STAT news reports that some patients are instead carrying simple syringes filled with epinephrine, which can be obtained for a total cost of about $20, instead of an EpiPen injector. Without training, however, the practice can be risky — accidentally injecting adrenaline into a vein instead of a muscle (which the EpiPen prevents) can be fatal. Others are stretching the devices past their expiration date, despite research indicating that the hormone is less effective after a year — and may not be enough if an emergency truly comes up.
Nonetheless, some states increasingly alarmed by the high cost of supplying EpiPens to emergency medical response teams — including Colorado, Maryland, and South Carolina — are pushing to train EMTs to administer syringes of epinephrine instead of EpiPens. Replacing the auto-injectors with syringes could potentially save taxpayers thousands; a county in Seattle where first-responders use generic kits of epinephrine instead of branded EpiPens reported savings of more than $150,000 in one year.