Allergy shot cost causes outrage

Company defends increase in EpiPen price, citing coupons that cover the co- pay and higher deductibles

Price for lifesaving shot up 150% since 2009

High- profile members of Congress, doctors and consumers lashed out at the maker of the lifesaving allergy shot EpiPen as the new poster child for what they called exorbitant drug price increases.

Mylan’s EpiPens are used to quickly treat the severe allergic reaction known as anaphylaxis, which can include swelling of the tongue or throat, shortness of breath and a rash.

The prices that insurers and employers negotiate with Mylan are up about 150% since 2009, according to Rx Savings Solutions, which represents businesses and insurance companies. The average wholesale price has increased nearly 500% in that time, says Michael Rea, a pharmacist and CEO of Rx Savings Solutions.

As outrageous as the EpiPen increases seem, Rea says, they aren’t that unusual and get attention now because parents are stocking up before their children go back to school and increasingly face steep out- of- pocket costs because of higher deductibles

Jackie Davis of Newport News, Va., and her husband, Cory, recently moved from health coverage through the military, which covered all costs for their son Michael’s EpiPens and asthma inhalers, to a commercial plan with a $ 6,000 deductible. She owed $ 283 for his inhaler and learned Tuesday that her cost after the coupon for three two- packs of EpiPens is $ 1,500. She can’t afford even one two- pack.

“For any kind of necessary medicine, you shouldn’t have to pay anything,” says Davis, who has three other children. “At the very least, the insurance should cover it if it’s prescribed by your doctor as a lifesaving thing.”

Consumer outrage prompted at least three senators to call on Mylan to address the high prices. Senate Judiciary Chairman Chuck Grassley, R- Iowa, demanded documents Monday showing how the cost can be justified.

Mylan defends its prices by noting in a statement it has given away about 700,000 EpiPens to schools since 2013 and provides coupons that cover the cost of copayments for most consumers with commercial insurance. The company also cited the problems caused by high- deductible plans.

Though the coupons mean many people don’t pay much or even anything out of pocket, the high costs are borne by employers or insurers and passed to all consumers in higher premiums and deductibles even when they don’t pay immediately.

The American Academy of Pediatrics ( AAP) approved a resolution last year to lobby Congress on EpiPen pricing. Michael Welch, a San Diego allergy doctor who wrote the AAP resolution, says he pressed Mylan President Rajiv Malik recently about the prices and says Malik stressed the giveaways and co- pay coupons.

“The bottom- line problem is that the price isn’t being addressed,” says Welch, a professor at the University of CaliforniaSan Diego School of Medicine.

High- deductible insurance plans are designed to get employees to shop smarter and can elicit an outcry over prices that doesn’t happen when insurance covers them, says Annette Guarisco Fildes, CEO of the ERISA Industry Committee, which represents the largest employers.

The 15% and higher increases in drug prices collectively drive overall premiums, says Mona Chitre, a pharmacist and chief pharmacy officer for Excellus BlueCross BlueShield, which serves Upstate New York. “The insurer ( and) the employer is still picking up the cost,” she says, “and it’s coming through on the premium.”

Tolly Epstein, an allergy doctor with Allergy Partners of Central Indiana, says many of her patients pay $ 600 to $ 800 for EpiPens because they have high- deductible plans that do not cover the cost.

When Michael Davis was 2, he vomited and his throat started closing up in an ambulance after he ate yogurt for the first time. After that experience, Jackie Davis wouldn’t take any chances with allergies or EpiPens.

Some of Epstein’s patients wonder, “Can I really afford this? Do I absolutely have to have it?” she says. “People are making choices that they might not make if the cost were not so high.”

“At the very least, the insurance should cover it if it’s prescribed by your doctor as a lifesaving thing.” Jackie Davis

RICH PEDRONCELLI, AP The price insurers and employers pay for the EpiPen, which treats severe allergic reactions, has increased about 150% since 2009.

CATE WILLING Jackie Davis of Newport News, Va., has a son named Michael, 7, who has severe food allergies and went into anaphylaxis when he was 2. Michael uses the EpiPen.