Karen Garloch

EpiPen prices anger Charlotte families that need them to keep kids safe

The price of an EpiPen epinephrine auto-injector, made by pharmaceutical company Mylan, has risen dramatically since 2007. On Thursday, in response to the national furor, Mylan announced it was expanding its financial assistance program for patients.
The price of an EpiPen epinephrine auto-injector, made by pharmaceutical company Mylan, has risen dramatically since 2007. On Thursday, in response to the national furor, Mylan announced it was expanding its financial assistance program for patients. AP

In 2005, when Jodi Stokes started buying epinephrine to protect her son from a severe allergic reaction to peanuts, a set of two EpiPens cost about $60. Today, the same pack costs about $600 – an increase of 900 percent.

That dramatic price increase has prompted congressional leaders to call for an investigation and has angered many parents, including those in Stokes’ support group, Parents of Allergic Kids, who worry their children could die if they can no longer afford to keep the life-saving medicine on hand.

“Some of our members have four kids with food allergies,” Stokes said. “You’re talking thousands of dollars per family.”

In response to the national furor, Mylan, the drug’s manufacturer, announced Thursday that it will offer discounts for families who can’t afford the out-of-pocket cost for EpiPens.

Most parents buy multiple EpiPen sets to keep at home, at school, in backpacks or purses, and with grandparents or other caregivers. After a year when the medicine expires, the pens must be replaced. So the cost mounts up.

“I used to be able to get six,” said Virginia Delaney of Davidson, whose son Matthew, 12, is allergic to peanuts. “Now I only have one set to carry all over the place. If he leaves it somewhere, we panic.”

A few months ago, Delaney used a $100-off coupon, which has been previously available from Mylan, and still paid $385 for a two-pack of EpiPens. Before Matthew returns to school, she said she’ll need to buy another set.

“It’s very upsetting to me,” she said. “This is not about a mosquito bite or something that needs a Band-Aid. This is a life-threatening thing.”

Price rose since 2007

The price of EpiPens has risen steadily since 2007, when Mylan purchased rights to the pen-like device, which was invented in the 1970. It’s a way to quickly deliver a pre-measured dose of the adrenaline-like drug – in a stab to the thigh – in case of anaphylactic shock. The drug, epinephrine, reverses swelling and closing of the airways that can occur when someone has a severe reaction to bee stings, peanuts and other allergens.

In 2007, the wholesale cost for a two-pen set was about $100, according to the New York Times. By July 2013 the price was up to $264.50, and it rose 75 percent to $461 by last May. In May of this year, the price spiked again to $608.61, according to the Times.

A “Stop the EpiPen Price Gouging” petition has emerged on social media. Sen. Chuck Grassley, the Iowa Republican, has called on Mylan to explain the price hike. And Sen. Amy Klobuchar, a Minnesota Democrat, whose daughter carries an EpiPen, has asked the Senate Judiciary Committee and the Federal Trade Commission to review whether the price hikes violate any anti-competition rules.

Other senators have called for an investigation into reports that Mylan executives gave themselves huge raises while raising the drug’s price. Even Sen. Joe Manchin, a W.Va. Democrat whose daughter, Heather Bresch, is chief executive of Mylan, weighed in Thursday, saying he shares his colleagues’ concerns about the skyrocketing prices of prescription drugs.

According to the Washington Post, Bresch’s total compensation went from $2.5 million to $19 million from 2007 to 2015, a period that coincides with the time when Mylan acquired the rights to EpiPens and steadily hiked the price.

Mylan has a virtual monopoly on EpiPens since last year, when drug maker Sanofi voluntarily recalled a competing device, Auvi-Q, because it may not have been delivering the correct dose. A generic product, called Adrenaclick, has been available since 2010, but many doctors don’t prescribe it, in part because it isn’t marketed as aggressively as EpiPens.

In its announcement Thursday, Mylan said it will increase its coupon offerings to $300 “for patients in health plans who face higher out-of-pocket costs.” The company said it would also double the income level at which families are eligible for financial assistance.

Free pens for schools

In a prepared statement, Mylan touts its EpiPen4Schools program, which has distributed more than 700,000 free EpiPens to U.S. schools since 2012. Each school in Charlotte-Mecklenburg Schools, a participating district, receives four EpiPens at no charge from Mylan, a CMS spokeswoman said. Mylan also replaces the pens for free after they’re used or after they expire.

Mylan also offers coupons that provide up to $100 savings for each EpiPen pack. “The majority of patients using the savings card have received, and continue to receive (EpiPens) for $0,” the company says on its website.

Indeed, Jodi Stokes can get EpiPens at no out-of-pocket cost after using her family’s insurance coverage and the Mylan coupon. But other parents in her group said their insurance doesn’t cover EpiPens.

Last November, Toni Becht of Matthews paid $371.68, or $92.92 each, for four sets of EpiPens for two of her three children who have serious food allergies. That was her out-of-pocket cost after applying Mylan’s $100-off coupons and getting a portion paid by her health insurance.

But in April, the cost had risen when she bought three more sets so her 16-year-old son Cameron would have them during an out-of-town band trip. By that time, the price had gone to $382.30 per box, for a total of $1,146. She paid the entire amount because her current insurance plan has a high deductible which she had not met. Again, she used Mylan’s $100-off coupons, but she said she still “drained” her Health Savings Account to pay for the pens.

“I had no choice,” Becht said. “I feel fortunate that I had the money in my HSA account to pay for it.…(Now we have to hope) there will be no real serious illness or hospitalization the rest of the year.”

Becht said she usually keeps five sets of EpiPens, so she’s putting aside money to buy more when the ones she has expire. But she’s not happy about it. “This is not a new drug,” Becht said. “There’s no reason why this drug has to cost this much.…Mylan still hasn’t satisfactorily explained, in my mind, the root cause for the increase in price.”

Lack of competition

Charlotte-area doctors say they’re hearing similar complaints.

Dr. John Klimas, an allergist with Carolina Asthma & Allergy Center, said he saw a patient this week, a man in his 80s, who’d been to the emergency room after being stung by yellow jackets. The ER doctor had prescribed an EpiPen but Klimas said the man told him, “I can’t afford it.”

“It’s just so much more expensive than it used to be,” Klimas said. “I have seen no major changes or improvements in the EpiPen since Mylan purchased the product in 2007.…I think it’s (about) marketing and having a monopoly on the market.”

Dr. Jennifer Caicedo, a pediatrician and allergist with Asthma and Allergy Specialists in Charlotte, said another big problem is that more patients have high deductible insurance plans, which means they’re responsible for more of the cost before insurance reimbursement kicks in.

When price is an issue, Caicedo said she and her partners are prescribing Adrenaclick, the generic pen-like device that costs about $100 less per box. Unlike Mylan, which sends marketing representatives to doctors’ offices to push their product, Adrenaclick’s manufacturer doesn’t have a big sales force to visit doctors and demonstrate the devices.

Caicedo said Mylan’s decision to expand financial assistance for patients is “a step in the right direction.”

“But it is not enough or a long term solution,” she said. “While Mylan’s increased discount will increase access for some, it does not address the underlying problem, which is the excessive cost of the medication.”

Karen Garloch: 704-358-5078, @kgarloch