Upper Ohio Valley weighs in on price spike in EpiPen

Area EpiPen users say price jump hits hard

Wendi Mitchell of Wellsburg holds an EpiPen, an injection device used in emergency situations involving life-threatening allergies. The devices, which are sold in two-packs, have risen in cost from about $94 nine years ago to $600 to $700 currently. Mitchell’s son, Alex, has an extreme peanut allergy, and one device is kept at school and the other with him. Mitchell said the price increase is especially galling, considering the EpiPen contains less than $10 worth of epinephrine, the active ingredient. — Mark J. Miller

Wendi Mitchell said her son, Alex, now 15, had his first severe allergic reaction to peanuts right after his first birthday.

Mitchell said she gave him a food that contained peanuts and it wasn’t long before Alex was in a life-threatening emergency.

“The day he got sick he just ate a little bit (of peanuts),” said Mitchell, adding her son’s lips swelled, he developed hives and fluid began to build in his lungs. “He passed out from lack of oxygen because of the fluid building in his lungs.”

Alex was rushed to the hospital, where his situation was helped with a shot of epinephrine. Alex stabilized, and his condition improved. That’s when the emergency room physician told his mother, “You know, he could have died.”

That scene is repeated in hospitals and other places hundreds of times per day, and many lives have been saved through a device called the EpiPen, manufactured by the Mylan drug company. The injection device, which contains epinephrine, the active ingredient, is like a miracle drug in that it can stop even the most severe allergic reactions to just about anything very quickly.

“It has to be (injected) because it’s so time-sensitive,” said Mitchell, adding the medication’s effects last about a half hour.

The device, according to The Associated Press, cost about $94 nine years ago, but the price has skyrocketed to between $600 to $700 retail in the last few years. The only way to obtain an EpiPen is through a doctor’s prescription.

Mitchell said she witnessed the price increase gradually over time.

“When I first got them, we paid zero dollars co-pay. For me, I feel (the price) has gone up in stages. The last time I picked up a two-pack I paid $287, and that was with the Mylan $100 off coupon,” Mitchell continued. She said she has shopped everywhere looking for a lower price. “The full price is $600 to $700. That would be for a two-pack. It comes with a trainer you can practice with. It’s been a godsend. My son can practice with the device. (Mylan) does offer coupons. They currently have a $300 off coupon.”

Mitchell said her son is a careful eater and hasn’t had to use the device. Still, he needs the device and has to know how to properly inject himself when the time comes, she added.

“There’s a junior and an adult version,” Mitchell said. “They only way it’s sold is in two packs now, and (the device) expires in one to one and a half years.

“My son carries one. You have to get permission from the school (to keep an EpiPen),” she noted.

Mitchell said many health insurance companies that offer pharmacy benefits will pay for some of the device, while the patient pays a co-pay. But not all insurance companies do. She said the price for the EpiPen was all the more shocking in that the active ingredient in pill form costs less than $10.

“It would be nice if they could take the old medication out and put new medicine in (the EpiPen),” Mitchell said.

The U.S. Food and Drug Administration categorizes the EpiPen as a medication and medical device, and it has to meet several standards, according to the AP.

Several other companies have offered a generic version of the EpiPen with mixed results. Many of the generic devices have been recalled because of injector malfunctions, according to the ABC News website. At the end of August, consumer pressure forced Mylan to offer a generic device at half the current cost. However, Mitchell said most generics don’t offer the practice device, which she said is critical. It’s uncertain whether the Mylan generic will come with a practice device.

Harry Dobler of Toronto has had a rough few years. He lost his job as a information technology specialist after downsizing at a Pittsburgh-based company. He was able to be re-trained at no cost through the Community Action Council and now drives a long-distance hauler.

Dobler said he and stepson Blake Rebres are supposed to carry EpiPens, but he has no pharmacy benefits, and his health insurance company considers the cost part of his insurance deductible, which is $2,500 annually.

“My stepson uses one,” he said. “I’m supposed to have one, and I do, but this one has expired. (Blake) has a lot of allergic reactions. He gets shots for (his allergies). Blake does have a medical card.”

Dobler said his family has had three different insurance companies in the past couple of years. Some of them have had pharmacy benefits and some haven’t. He said Blake keeps one EpiPen at school, while another is kept at Blake’s father’s house.

“We keep the (unexpired) one with him at school,” said Dobler, adding the school only allows unexpired EpiPens to be housed there.

Dobler said he keeps an EpiPen with him, but it expired four or five years ago.

“I know when I purchased mine four or five years ago it was $150,” he said.

Dobler said he and Blake usually just use Benadryl if they feel an oncoming allergic reaction, and, “that usually takes care of it.”

With Congress slated to investigate the large price increase for the EpiPen after a public outcry, local pharmacist J.J. Bernabei said he understands and sympathizes with his customers.

Bernabei, owner of the Tri-State Medical Group, three retail pharmacies, one long-term care pharmacy and a home medical supply company, said he’s witnessed pharmaceutical costs skyrocket during the past 10 years. He said most people don’t notice the increase because many insurance companies pay for medications, while the patient typically pays a lower co-pay.

He said price increases in medications and health care have changed dramatically since he began as a pharmacist 25 years ago. Bernabei said price increases in the health care field are like no other.

“It was rare (when I began) for a (pharmaceutical) company to raise a medication’s price 2 or 3 percent to keep up with inflation,” he said, adding now it’s common for many companies to raise prices double-digits in a relatively brief amount of time.

“We see some (medication) prices go up 20 percent in a year,” he said, adding many times consumers don’t see the increase because their insurance company will pay for it. “Virtually no one pays (the full cost) for their health care.”

However, some medications have risen so quickly the patient begins to see the increase in the form of insurance co-pays, while some insurance companies only pay for certain medications.

“(The consumer) is going to go where it costs less,” Bernabei continued, adding it is a “tragedy” so many patients are having to pay such high prices for needed medications in the form of co-pays. “The patient’s biggest concern becomes if (he or she) can afford it. As the cost of all (medical-related care) goes up, there’s an increase, and someone has to pay for it.”

Bernabei supplied information — entitled “Epigate” — from the truthRX.org website that states the actual cost the Mylan company charges for the EpiPen double pack is $275. However, as the medication goes through the cycle of getting the product to retail, the device goes through several “middlemen,” each marking up the device.

The information shows brokers charge an additional $25 to the initial $275 manufacturer’s price, while pharmacy benefit managers and health care providers tack on an additional $259. The product then goes to wholesalers — adding another $20 to the device — and then to pharmacy retailers, who typically charge about a $30 markup for the EpiPen, according to the website.

“Why did the EpiPen go up so much?” asked Bernabei. There are no price controls for what middlemen can charge, he said. “Because it can. The free market element you had is now eliminated.

“There are a lot of middlemen in between when you get a prescription who raise the price before it gets to market,” he continued. “It should work the other way around. There’s a flaw in the system.”

A quick Google check revealed pharmacy benefit managers “act as an intermediary between the payer and everyone else in the health care system. They generally make money through service fees from large customer contracts for processing prescription claims, operating mail-order pharmacies and negotiating prices with drug makers,” according to the website www.whorunsmydrugplan.com.

Bernabei said it’s no mystery to him why the increases are so drastic, and he said he feels for his clients when faced with an exponential increase for a needed medication.

“To cut to the chase, there’s no incentive to keep things cheap (in the health care industry),” he said. “There are just too many middlemen. The administrative costs are crazy.”

(Miller can be contacted at mmiller@heraldstaronline.com.)



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