The pinch of EpiPen’s pric­ing

Modern Healthcare - - NEWS - By Adam Ruben­fire

Lisa Deck buys EpiPens for her two sons, ages 2 and 4, who have se­vere food al­ler­gies.

The de­vices, known as ep­i­neph­rine auto-in­jec­tors, can mean the dif­fer­ence be­tween life and death for 1 in 50 Amer­i­cans who suf­fer from ana­phy­lac­tic re­ac­tions. Auto-in­jec­tors de­liver a one-time dose of ep­i­neph­rine, also known as adren­a­line. The drug opens up a per­son’s air­ways, re­duces swelling and sta­bi­lizes blood pres­sure.

“It’s not a choice; I need them,” Deck said about pay­ing $440 for each car­ton of the de­vices this year un­der her high-de­ductible health­care plan. The av­er­age price for one in­jec­tor in 1986 was just un­der $36.

Ex­perts say reg­u­la­tory chal­lenges and the li­a­bil­ity drug­mak­ers could face if just one de­vice fails are hur­dles to creat­ing a com­pet­i­tive mar­ket. That means pa­tients and par­ents of chil­dren who could suf­fer from ana­phy­lac­tic shock and ac­count for the highest per­cent­age of pre­scrip­tions face high costs and frus­trat­ing re­al­i­ties.

Deck, who likes her high­d­e­ductible plan be­cause it helps her con­trol med­i­cal costs, has a sis­ter who gets EpiPens with no co­pay­ment.

My­lan’s name-brand EpiPen— which comes in a two-in­jec­tor pack be­cause pa­tients some­times need a sec­ond dose—costs con­sumers about $535 when pur­chased un­der two ma­jor in­surance plans, be­fore a $100 coupon, ac­cord­ing to sam­ple data from Ora­tion, a soft­ware com­pany that helps com­pa­nies and their em­ploy­ees re­duce pre­scrip­tion costs. Out of pocket, the de­vice can cost as much as $574 with the dis­count.

Cus­tomers of­ten buy mul­ti­ple de­vices to have at school or work, and the de­vices ex­pire, which means they must be re­placed ev­ery year, even if they’re un­used. Some stud­ies have sug­gested that the year­long shelf life ap­proved by the man­u­fac­turer and the Food and Drug Ad­min­is­tra­tion may be con­ser­va­tive.

For most drugs or de­vices, pa­tients might shop around. But Dr. Bobby Lanier, a Fort Worth, Tex­as­based al­ler­gist, said most of his pa­tients end up us­ing EpiPen rather than com­peti­tors such as Adrenaclick, which is made by Hor­sham, Pa.-based Ame­dra Phar­ma­ceu­ti­cals.

Mul­ti­ple es­ti­mates put EpiPen’s share of the ep­i­neph­rine auto-in­jec­tor mar­ket at about 85%. Am­s­ter­dambased My­lan de­clined to com­ment for this story, as did a num­ber of phar­macy ben­e­fit man­age­ment com­pa­nies and in­sur­ers.

Con­sumers and ex­perts who spoke to Mod­ern Health­care about ep­i­neph­rine auto-in­jec­tors didn’t have sig­nif­i­cant ex­pe­ri­ence with Adrenaclick and noted that it isn’t al­ways cov­ered by in­sur­ers.

That in­cludes Ch­eryl Fruiter­man, a food al­lergy sup­port group leader in Al­bany, N.Y., who pur­chases EpiPens for her hus­band and 12-year-old son. Fruiter­man said she pays noth­ing un­der her hus­band’s “Cadil­lac” health plan.

Even with lower de­ductibles, some in­sur­ers place lim­its on the num­ber of auto-in­jec­tors cov­ered each year, so con­sumers who have mul­ti­ple ana­phy­lac­tic episodes may end up spend­ing higher out-of-pocket amounts.

Com­pe­ti­tion could drop the price of EpiPens, but a de­vice can never fail, Lanier said. There­fore they go through ex­haus­tive, con­tin­u­ous test­ing that con­sti­tutes a sig­nif­i­cant cap­i­tal in­vest­ment for a drugmaker.

A would-be ri­val, Auvi-Q, was re­called by French drugmaker Sanofi be­cause the de­vice re­port­edly de­liv­ered an in­ad­e­quate dose. Is­rael-based Teva Phar­ma­ceu­ti­cal ex­pects to mar­ket a generic ver­sion of EpiPen this year.

Moody’s In­vestors Ser­vice said in Novem­ber that My­lan’s “even­tual loss of ex­clu­siv­ity” in the EpiPen mar­ket won’t hurt the com­pany too much given other prod­ucts in its pipeline.

Fruiter­man wel­comes com­pe­ti­tion, not be­cause of the cost, but be­cause of the in­no­va­tion it brings. Her son and hus­band liked Auvi-Q, which fit in their pocket un­like the long, cir­cu­lar EpiPen. Her in­surer, how­ever, didn’t cover Auvi-Q.

For Deck, it boils down to cost. If her doc­tor pre­scribed a lower-cost equiv­a­lent to the EpiPen that was safe and ap­pro­pri­ate, “I would, of course, choose the lowest-price op­tion,” she said.

Cus­tomers of­ten buy mul­ti­ple EpiPen de­vices to have at school or work, and the de­vices ex­pire, which means they must be re­placed ev­ery year, even if they’re un­used.

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