EpiPen: $700 for less than $1 of medicine

By Dr. Jeff Daniels EBS Medical Columnist

Is it inevitable that the price of the medicines we rely on will only be affordable to the rich?

Another example of this disturbing trend emerged recently when the price of a dispensing device for a life-saving drug increased to a point where many people are concerned they can’t afford it, with or without insurance. Why should such an essential drug, used by millions of people, be priced like a luxury?

An EpiPen is a very convenient way to administer the drug epinephrine, also known as adrenalin. Epinephrine is an immediate acting treatment once a severe allergic reaction is initiated in those with insect sting or severe food allergies, or any other reason for an anaphylactic reaction.

When someone with high allergic sensitivity is exposed to the offending substance, a certain segment of the body’s immune defenses lead to the excessive release of chemicals such as histamine. This can cause generalized itching, swelling of the face, hives, difficulty breathing, and a drop of blood pressure to the point of shock; and anaphylactic shock can prove fatal. Epinephrine reverses this process very quickly.

The auto-injector technology behind the EpiPen was first developed by the military for administration of an antidote against nerve gas. Since it became publicly available around 1980, the EpiPen has been recognized as a legitimate way to carry or store this drug, and have it ready for emergency use. Here in Montana, an EMT can also administer it if a severe reaction prevents a person from self-administering the drug.

Mylan Pharmaceuticals, who bought the rights to manufacture the EpiPen from Merck & Co. in 2007, has consistently raised the price. It now costs about $700 to purchase two EpiPens—they’re always sold as a “two-pack.” Since the drug that’s in the EpiPen has a shelf life of about a year, technically they should be replaced annually. For a child with a life-threatening peanut allergy, that could add up to a year of college tuition by the time they graduate high school! The vast majority of EpiPens that are prescribed are never used because most patients learn to avoid the substance that gives them anaphylaxis.

I’ve used epinephrine out of a bottle during my work both as an allergist and at my Big Sky practice. The same amount of the drug that is injected out of an EpiPen costs 10 cents; the needle used for administration of the epinephrine costs 15 cents. For my patients who can’t afford an EpiPen, I have supplied many pre-filled syringes of epinephrine.

The cost of an EpiPen has increased tremendously since they were first introduced. Mylan is in the spotlight now and there are congressional hearings to get answers as to why the costs are skyrocketing. One reason could be the fact that Auvi-Q, a similar product, was recalled in 2015 because of the possibility of inaccurate dosing. There are some other products on the market that deliver epinephrine for even more money, but EpiPen has the lion’s share of sales.

On Aug. 29, Mylan announced that it would offer a generic version of their brand EpiPen for approximately $300. This news prompted Vermont Sen. Bernie Sanders to tweet: “At $300 generic EpiPens will still cost 3 times more than they did in 2007. This isn’t a discount. It’s a PR move.” I agree, but at least it’s a move in the right direction!

Dr. Jeff Daniels was the recipient of the 2016 Big Sky Chamber of Commerce Chet Huntley Lifetime Achievement Award and has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.