As a physician with a political column, there is one topic I haven’t been able to escape of late: The EpiPen. [OK, two questions. No, I don’t think you can diagnose Sec. Clinton with a seizure from a campaign video.]
Epinephrine, the medication in the EpiPen, has been saving the lives of patients with severe allergic reactions for decades. In the hospital, nurses draw it up from a bottle with a syringe and inject the patient, whose breathing becomes easier almost immediately. The EpiPen is a way for patients to inject themselves or others successfully with little training. Originally prescribed to patients known to have severe allergies, EpiPens are found almost anywhere a patient might have an allergic reaction, which is everywhere.
What soured public opinion on a lifesaving medication? The price, which by some measures has increased over 500 percent in nine years.
Is the EpiPen worth the May 2016 two pack price tag of $600 (The patient cost varies with insurance)? Absolutely. Anyone who has gasped for air from an allergic reaction, or watched someone else suffer one, would be happy to pay far more.
Does the EpiPen need to cost $600? Not based on the production cost. The epinephrine itself is inexpensive and the delivery system isn’t new. Demand has been rising, which usually lowers per-unit costs unless there is a shortage of materials.
Why does Mylan, the company that makes the EpiPen, charge $600? They have no competition, so they can. Or at least they could until people noticed. Mylan recently announced they will sell a generic version of the EpiPen for half the price. That will help some people, but it seems equally arbitrary. When Mylan bought the rights to the EpiPen in 2007, it cost about $60 according to the New York Times. Adjusted for inflation, that would be $70 now.
I suspect Mylan will be accused of price-gouging and investigated by someone in government for something. My guess is that they will only be found guilty of making as much money as possible while they could. Apple does the same thing, but we only want Apple products. We need Mylan’s EpiPen. That difference is emotionally obvious, but hard to represent in balance sheets and regulations. Hard, but not impossible, and we should be trying to make the math work for patients and pharmaceutical companies.
Tempting as it might be to slash the price Mylan can charge, we are worse off if Mylan has insufficient incentive to keep making EpiPens. The same is true for drugs for Hepatitis C and HIV that are just as lifesaving and just as out of reach for some patients. An America that leads in both pharmaceutical research and access to medications isn’t too much to ask for. Mylan earned their week of bad press, but we should focus on fixing the broader system, not the price of the EpiPen.
