Health Care

Alarming rise in cost of lifesaving EpiPen devices

The rising cost of EpiPens, potentially life-saving devices for those with severe allergic reactions, has patients worried if they can afford them.
The rising cost of EpiPens, potentially life-saving devices for those with severe allergic reactions, has patients worried if they can afford them. The Associated Press

For some people, falling prey to a bee sting or accidentally eating a peanut can mean death.

Now skyrocketing costs of a pocket antidote — the EpiPen — adds another form of panic.

When the severe allergies strike, calling 911 can’t hope to bring help soon enough to people with a severe reaction. So they reach for the gadget about the size of a highlighting pen.

It carries a cheap, long since generic drug that can reverse a severe drop in blood pressure, a speeding heart rate and the swelling shut of an airway. In short, it’s a lifesaver.

The cost of those EpiPens — a trademarked device made by Mylan N.V. — has quickly soared. When Mylan bought the rights to the autoinjector in 2007, a pair of its EpiPens sold for less than $60. Now they can sometimes cost patients more than $600.

Kansas City doctors said their patients talk with mounting anxiety about the runaway expense. Physicians typically recommend keeping two epinephrine, or adrenaline, injectors constantly at the ready for people with the life-threatening allergies.

For children, that means two at home and two at school. Because the drug in the gadgets has a shelf life of about a year, parents can be looking at $1,200 annually.

“They know this is something they can’t go without,” said Jay Portnoy, the director of the Pediatric Allergy, Asthma and Immunology Clinic at Children’s Mercy Hospital. “They have to struggle to come up with the money.”

Price boosts have been steady, but they accelerated recently after a key competitor to Mylan’s EpiPen fell out of the market. The Auvi-Q version of the gadget made by Sanofi US was recalled in November 2015. Teva was denied regulatory approval to sell a version early this year.

Another version of the device, Adrenaclick made by Amedra Pharmaceuticals, can sometimes be found for less than $150 for a single shot — although some pharmacies charge more than double that amount. It has not been marketed to doctors nearly as aggressively as the EpiPen or the now-unavailable Auvi-Q.

Doctors in the United States prescribed EpiPens more 3.6 million times last year.

“Mylan … is exploiting a monopoly market advantage that has fallen into its lap,” Sen. Amy Klobuchar, a Democrat from Minnesota, said recently. She called on the Federal Trade Commission to investigate the pricing. Sen. Charles Grassley, an Iowa Republican, wrote to Mylan demanding an explanation for price increases.

Mylan did not respond to a request for comment for this article.

The Dutch company reported a 33 percent increase in sales in the second quarter of this year in its specialty drug segment, which includes the EpiPen. Mylan CEO Heather Bresch told analysts in an earnings call earlier this year that the company was concerned about how shifting insurance coverages could hurt EpiPen sales.

“As employers shift more costs to employees and make everything come out of pocket, that’s where you’re seeing a lot of the noise around EpiPen,” she said.

EpiPen costs have generated harsh criticism of Mylan. (Mylan offers an online coupon that can save up to $100 and a patient assistance program.)

Even Martin Shkreli, known as the “pharma bro” much derided for buying rights to a lifesaving drug and then briefly boosting the price from $13.50 a tablet to $750, lashed out at the company.

“These guys are really vultures,” he told NBC News. “What drives this company’s moral compass?”

Clinicians have eagerly prescribed EpiPens and similar devices since their invention in the late 1970s. They contain precise doses of epinephrine, about $1 worth.

The magic of the gadgets comes in how virtually anyone can put them to use in a crisis, and in an instant. Remove the cap, press against the thigh, press for a few seconds. Done.

“They’re simple to use. They have to be,” said Stephen Lauer, an associate professor and associate chairman of pediatrics at the University of Kansas Hospital. “The worry going forward is that it’s going to put some families into having to make some tough decisions.”

Do, for instance, they chance things by keeping one device, rather than two, on hand? Do they risk letting an autoinjector go beyond its expiration date without replacing it? Lauer and other clinicians warn against taking such risks with a lifesaving drug delivery gadget.

Physicians say some patients talk about getting a dose of the cheap epinephrine and a syringe. It would be a tiny fraction of the cost. But doctors discourage that approach.

Imagine drawing a dose into a syringe when your heart is racing and your throat is swelling shut? Or while watching those symptoms consume your 4-year-old?

Even a calm layperson could get it wrong, hitting a blood vessel, causing it to shut off and fail to deliver the drug. Autoinjectors penetrate the skin at a precise depth.

“Once you have to start carrying around syringes with needles,” Lauer said, “that’s much more problematic.”

Some emergency rooms save money by relying on the skills of doctors and nurses to deliver the dosage with a syringe.

But not at Children’s Mercy.

“Even an experienced clinician might be flustered or panicked in that situation,” said Portnoy. “We want to make it as simple as possible.”

Likewise, the Kansas City Public Health Department purchases EpiPens to have on hand in case someone has an allergic reaction to a vaccine. And it’s seen the cost go up.

The health department buys in bulk and gets discounts, but in two years it’s seen the cost of a two-pack of EpiPen Jr go from $397.14 to $689.70.

Scott Canon: 816-234-4754, @ScottCanon

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