The Lesson of EpiPens: Why Drug Prices Spike, Again and Again
Elisabeth Rosenthal, editor-in-chief of Kaiser Health News and the author of the forthcoming An American Sickness: How Healthcare Became Big Business and How to Take It Back, writes in the NY Times:
When I was a kid in the late 1960s, I suffered from serious asthma attacks. About twice each summer, struggling for air, I received a shot ofepinephrine drawn up in a syringe from the camp nurse. The relief was nothing short of miraculous.
Today that same tiny, lifesaving bolus of epinephrine — used mostly to treat severe allergic reactions — is delivered via sometimes elaborate devices called auto-injectors. Though the medicine itself hasn’t changed, the delivery devices have been protected by patents, enabling drug makers to charge ever escalating — sometimes prohibitive — prices for one of the oldest drugs in medical use.
Though Mylan, the maker of the EpiPen auto-injector, had been raising prices by 20 percent annually in recent years without much blowback, it set off political outrage last month by raising the price to over $600 for two pens just before parents were buying new EpiPens for their school-bound children. Heather Bresch, the chief executive of Mylan, suddenly found herself in the same penalty box as Martin Shkreli, the pharma bad boy, who last year raised the price of an old drug for parasites, Daraprim, by over 5,000 percent. Members of Congress called for hearings. Hillary Clinton denounced Mylan on Twitter.
To mitigate the widespread outrage, Mylan first announced that it would give insured patients $300 coupons to offset the higher price and then, last week, that it would make a cheaper generic version of its own product. Patients may have, once again, won a battle. But they are losing the war on high drug prices.
Ms. Bresch was in many ways acting in accordance with a core strategy in the pharmaceutical industry’s playbook — take something old and repackage it to make it new and patentable — and then see what price the market will bear. Sometimes extortionate prices are a predictable outcome. Yet the government has no real tools to curb them.
Many other old medications have been delivered in new packages in recent years, with startling price increases. Basic asthma inhalers, which once cost under $15 (and still do in many countries), cost $50 to $100 in the United States. A portion of the big price rises for insulin in recent years is attributable to new types of injectors to deliver the medicine. Long-off-patent emergency rescue drugs delivered by auto-injector — not just epinephrine, but also glucagon to ward off diabetic coma and naloxone to reverse opiate overdose — have seen particularly perplexing price escalations.
New devices can make it more convenient and safer to deliver a lifesaving drug during a medical crisis. But when is new packaging — often accompanied by bells and whistles of uncertain value — worth an exponential rise in price? That’s something a nation struggling with a $3 trillion health bill must consider, and it merits a response beyond a few days of executive public shaming. . .
Somehow, I’m reminded of the introduction of cartridge razors and the price escalator for those, to the point where a single cartridge can cost more than a year’s supply of DE blades—plus the DE razor is kinder to the skin and delivers a better shave: better result, better experience.