# The cost of Epipens



## weedygarden (Apr 27, 2011)

It is all over the news and there is so much of an uproar about it. There might be better articles out there.

http://money.cnn.com/2016/08/25/investing/epipen-cost-ceo-lowers-price-mylan/



> EpiPen CEO: Blame the 'broken' system, not me
> 
> Heather Bresch, the Mylan CEO under fire for skyrocketing EpiPen costs, believes Americans should redirect their anger toward a "broken" health care system.
> Mylan (MYL) was forced to respond to the national outrage over a more than 400% increase in price for the lifesaving allergy treatment by pledging on Thursday to make it more affordable.
> ...


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## weedygarden (Apr 27, 2011)

*A suggested alternative*

http://abc22now.com/news/local/epinephrine-injection-kit-for-under-10



> Epinephrine injection kit for under $10
> BY CHRISTIAN HAUSER THURSDAY, AUGUST 25TH 2016
> 
> HAMILTON (WRGT)-- If your child has an allergy you are probably aware of the increasing cost of the EpiPen from Mylan.
> ...


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## weedygarden (Apr 27, 2011)

*Necessity is the Mother of Invention*

One of my former colleagues said that some high school kid will use a 3-D printer and will come up with an alternative. I think the company that is charging so much for the Epi-pens right now owns the rights to the patent. Personally, I would love to see someone invent an alternative and put those greedy buzzards out of business.


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## backlash (Nov 11, 2008)

There were 2 other companies that tried to market an alternative.
Both were shut down by the FDA.
Wonder who got that done?
Must be nice to be a CEO with a dad in the Senate.

https://consumerist.com/2016/08/24/6-things-you-should-know-about-heather-bresch-the-ceo-behind-epipen-price-hike/


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## weedygarden (Apr 27, 2011)

backlash said:


> There were 2 other companies that tried to market an alternative.
> Both were shut down by the FDA.
> Wonder who got that done?
> Must be nice to be a CEO with a dad in the Senate.
> ...


That may be why the best alternative is to learn to give an injection. I know that is not ideal, and for some people, impossible, but it could work for some.

I think I have mentioned this before. Friends of mine had a 14 year old son who developed diabetes. Mom took full control of his care. Kid depended on that and so did the father. Mom went out of town for a few days and all of a sudden dad and son had to be the responsible ones. There were many phone calls and scary moments until they paid attention. I believe this would be true for injections. Some will be able to assume responsibility, and some wouldn't or couldn't.


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## DrPrepper (Apr 17, 2016)

weedygarden said:


> That may be why the best alternative is to learn to give an injection. I know that is not ideal, and for some people, impossible, but it could work for some.
> 
> I think I have mentioned this before. Friends of mine had a 14 year old son who developed diabetes. Mom took full control of his care. Kid depended on that and so did the father. Mom went out of town for a few days and all of a sudden dad and son had to be the responsible ones. There were many phone calls and scary moments until they paid attention. I believe this would be true for injections. Some will be able to assume responsibility, and some wouldn't or couldn't.


Weedy, I agree with you completely. Giving an injection is very easy- the hardest part is getting over the feeling of sticking somebody! But...... only problem with that is it takes a bit of time to clean the bottle top, draw up the correct amount and then inject. Epipen is faster, but with practice, the time difference is negligible.

One of the biggest problems with health care costs today is price gouging by pharmaceutical manufacturers. For example, this week we learned that a particular injectable blood pressure drug that we have used for years because it is efficient, cheap (just a couple of dollars a dose), and has very few side effects for the patient is now going to cost us about $100 per dose! (And that doesn't include the mark up to the patient!). The reason? Several generic companies merged and sold the patent. Now, the new company is the only manufacturer of this drug, and they have raised the price to ridiculous levels. So..... we are now substituting similar drugs for this one wherever it is safe to do so.

In defense of the pharma companies, they do incur costs for research and development, and they also have taxes and litigation costs to deal with. However, I think that if they spent less on advertising their products to the public (instead of to the providers), they could knock a substantial amount off the price. They also could reduce their profit margin a bit to make their products more affordable.

I think the biggest drivers of big pharma are not the stockholders (although they play a huge role!), but rather public opinion. We invent a disease or syndrome for everything and then we want a pill to cure it. Look at how much money is spent on hyperactivity drugs for kids, when in 95% of the cases, reducing the sugar and caffeine in the kid's diet and providing some parental guidance/ discipline would solve the problem without the meds. I was told by my son's teachers that he was hyperactive and I needed to start him on Ritalin. The problem? He was bored to tears in class, which was causing him to act out. Once we figured out ways to keep him intellectually stimulated, his "hyperactivity" went away. Americans want a quick fix for everything. Are you in pain? Take some pain meds. Have heartburn? take a pill. Need help with your love life or want to lose weight? There are pills for that, too. I am not opposed to medication for true medical conditions- just opposed to taking a pill when there are other things that could do the same thing, but might require a little energy.


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## Tweto (Nov 26, 2011)

This is something that the media won't report.

Mylan labs (manufacture of the EPI pen) is run by CEO Heather Bresch, her father is Senator Joe Manchin (D) and he is a close personal friend of the Clintons and works on Hillarie's campaign.


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## hiwall (Jun 15, 2012)

Either you have a free market or you don't. The free market works well but in this case it is not a free market because the government is involved. Why don't all the media tell the truth- that this company can charge any amount they want because they paid off the correct elected and appointed officials.
If this really was a free market the cost would likely be something like $39.99 with occasional $5 off coupons found in the newspaper.


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## terri9630 (Jun 2, 2016)

I've never understood the marketing to the general public.


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## DrPrepper (Apr 17, 2016)

terri9630 said:


> I've never understood the marketing to the general public.


terri,
It used to be that people went to see their doctor (or NP or PA) because they were sick and needed the expertise of the care provider to get better. Now, though, with all of the public marketing, people come to see their provider to get a prescription for the latest wonder drug they saw on TV or read about on the internet. This puts a huge amount of pressure on the providers- if they don't give the prescription, the patient may not come back (economic impact on the provider's business). If they do provide the prescription, it may not be the best choice for the patient's condition (moral quandary- make the patient happy? or make the patient better?) I am all in favor of educating patients about the different kinds of medications that are available because patients and care providers should have a partnership. However, I get really frustrated with patients who self-diagnose by reading things on the internet and then make demands for prescriptions for the conditions the patient diagnosed! There is a reason that many drugs are not over the counter. Most people do not understand the pharmacokinetics and pharmacodynamics (how the drugs work to fix a condition, how the drugs react in your body, and how they interact with other medications, foods, and products). A former neighbor of mine is a perfect example. She was getting older, was overweight, did not exercise, had an extremely unhealthy diet, and any time she went outside and worked in her garden, she would get sore. She decided she had fibromyalgia and needed Lyrica to treat it. She went doctor-shopping and saw at least 6 different doctors (that I know of) until she finally found one willing to write the prescription. The lyrica did not help her pain, but it did make her sleepy most of the time, altered her mood to cause depression and irritability, and exacerbated her congestive heart failure. This is a prime example of marketing to the public gone awry.

Drug companies know that the consumer can pressure providers into prescribing their drug, and THAT is why there is so much marketing to the public.

Sorry, this is a soap box issue for me!!
:soapbox1:


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## backlash (Nov 11, 2008)

I went to see my urologist a couple years ago.
At the end of the appointment he asked if there was anything else I wanted to talk about.
I said no we covered what I wanted.
He said I was one of the first men that hadn't asked him for a free sample of Viagra.
He hated the commercials that said ask your Doctor.

My biggest complaint with drug companies is they keep changing what is normal.
They changed the number for high cholesterol.
Then you are suddenly sick and you have to take their new wonder drug to get to the new normal.


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## terri9630 (Jun 2, 2016)

DrDianaAnderson said:


> terri,
> It used to be that people went to see their doctor (or NP or PA) because they were sick and needed the expertise of the care provider to get better. Now, though, with all of the public marketing, people come to see their provider to get a prescription for the latest wonder drug they saw on TV or read about on the internet. This puts a huge amount of pressure on the providers- if they don't give the prescription, the patient may not come back (economic impact on the provider's business). If they do provide the prescription, it may not be the best choice for the patient's condition (moral quandary- make the patient happy? or make the patient better?) I am all in favor of educating patients about the different kinds of medications that are available because patients and care providers should have a partnership. However, I get really frustrated with patients who self-diagnose by reading things on the internet and then make demands for prescriptions for the conditions the patient diagnosed! There is a reason that many drugs are not over the counter. Most people do not understand the pharmacokinetics and pharmacodynamics (how the drugs work to fix a condition, how the drugs react in your body, and how they interact with other medications, foods, and products). A former neighbor of mine is a perfect example. She was getting older, was overweight, did not exercise, had an extremely unhealthy diet, and any time she went outside and worked in her garden, she would get sore. She decided she had fibromyalgia and needed Lyrica to treat it. She went doctor-shopping and saw at least 6 different doctors (that I know of) until she finally found one willing to write the prescription. The lyrica did not help her pain, but it did make her sleepy most of the time, altered her mood to cause depression and irritability, and exacerbated her congestive heart failure. This is a prime example of marketing to the public gone awry.
> 
> Drug companies know that the consumer can pressure providers into prescribing their drug, and THAT is why there is so much marketing to the public.
> ...


I understand completely. I figure that my doctor went to school for 90 years to learn stuff and knows more than I do. My current Dr has a sign in one of the rooms that says "Thanks to Web MD, I'm getting a summer home".


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## drfacefixer (Mar 8, 2013)

backlash said:


> There were 2 other companies that tried to market an alternative.
> Both were shut down by the FDA.
> Wonder who got that done?
> Must be nice to be a CEO with a dad in the Senate.
> ...


Im not sure which two companies you are speaking of. Auvi-Q and twinject had voluntary recalls for inaccurate dosing. It wasn't the FDA that shut, then down. It was big pharma fights on patents. It is not about the epinephrine. The issue is that the injector has to be a registered medical device. Mylan, did use backdoor congressional legislature to get into the schools though. Had they not hooked the school programs on the use of only their product, I wouldn't have an issue with it. And of course, I do have issue with price gouging and lack of alternatives.

As someone who deals with allergies and anesthesia everyday, the more available epi is the better.( same with AEDs) There has been legal issues in most states for decades on who can carry and treat with epi. Wasp stings kill more people than snake bites, bears, and pretty much anything else in the woods, and yet few states allow trained park rangers to carry and administer the drug. Believe it or not, that's a turf fight with EMTs.

Twinject had my all time favorite design. two doses in one sleek pen


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## drfacefixer (Mar 8, 2013)

weedygarden said:


> One of my former colleagues said that some high school kid will use a 3-D printer and will come up with an alternative. I think the company that is charging so much for the Epi-pens right now owns the rights to the patent. Personally, I would love to see someone invent an alternative and put those greedy buzzards out of business.


I would disagree with you on this. The autoinjectors are not very complicated. Half the people on this forum could probably come up with something that would work. The problem is that your compiling an immediate lifesaving zero fault tolerance FDA approved medical device. If one out of a few thousand fail or give inaccurate dosing, you and your business are sunk.

I carry 1mg epi ampules because they are smaller than two epipens and that allows me to give 0.3mg - 0.5mg doses IM to cover different issues. But then again, I have lived anaphylaxis and have treated it in emergency settings multiple times.

Many of the people affected by this are families with young kids dealing with food allergies. You can't be with your child at all times. Unless a kid is insulin dependent, they wont completely understand having to give themselves an injection. Diabetic kids learn quickly that insulin is a necessity. They experience hypoglycemia. They experience diabetic diabetic ketoacidosis. They know what lies ahead. Young kids experiencing allergy related anaphylaxis get scared. Many times they are unsure if they were exposed to an allergen and just how bad the reaction may be. They don't know if they their eyes are tearing and their throat and nose is stuffy because they are at the start of a reaction or because they are crying and scared. Autoinjectors work well for this population. They can be taught a two step life saving procedure that is more akin to a rubber band snap than an injection. Its quick, its shocking, but its not really painful.

There are two more companies seeking FDA approval. It will be interesting to see where they price themselves. Mylan just offered a $300 generic as an alternative. THis is pretty much the same cost as their $600 with a maximum $300 off coupon (this depends on insurance plans). Adrenaclick retails at $300 as well, but has a $100 off coupon. The funny thing is my insurance EOB only pays $149 along with my $17 copay for the mylan epipen brand. They are goughing the poorly insured, uninsured, and the institutions that are either mandated or expected to have them - most dentists, doctors, EMTs, police, schools, ect.


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## backlash (Nov 11, 2008)

I had an N.B.C. (nuclear, biologic,chemical) training class in the Navy.
At the end of the class the instructor gave each of us a tube of inert liquid that we had to inject into our self.
It looked like a tube of toothpaste with a needle attached.
Just twist the end off the needle and stick it in your leg squeeze the liquid in your thy.
Took me 15 minutes to get it done and there were a lot of others still there an hour later.
They did have an auto-injector but the instructor said it hurt way too bad to use in training.
I can see why the epipen is better.


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## weedygarden (Apr 27, 2011)

http://minnesota.cbslocal.com/2016/09/13/epipen-alternative/



> Twin Cities Doctor Creates $50 EpiPen Alternative
> September 13, 2016 8:52 PM By Edgar Linares
> Filed Under: Edgar Linares, Epinephrine, EpiPen
> 4
> ...


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