Dr. Kevin Most: EpiPens

Doctor Kevin Most

Doctor Kevin Most

We spoke last week about the impact of changes that we are seeing in insurance products. One of the changes is the high deductible that many individuals are choosing. We talked briefly about how this has impacted many individuals and how they care for themselves and the decisions they make regarding care and medications.

This week we are hearing in the news about the big increase in the cost of Epi Pens. Many of you have probably never heard of an Epi Pen, but those of you who have one sure understand its importance. Let’s discuss what an Epi Pen is and what does it treat. To start it is not an actual pen, it does not write anything. It looks like a pen and thus it has the name Epi Pen. The Epi pen is an auto injector. It allows for a dose of epinephrine to be administered immediately by the patient and not under a doctors direct supervision. The pen is an auto injector and is designed for a non medical person to stick it in their leg and deliver the needed medication quickly and safely. This has been used thousands of time with great success. It can give patients the time needed to get to the emergency room for more definitive treatment. Without this treatment immediately the patient with a severe allergic reaction may die.

Epinephrine also known as adrenaline is used to treat allergic responses. It is a substance that is made in the human body and was identified over 100 years ago. Individuals who are exposed to a substance that they are highly allergic to, have reactions that can be life threatening. This includes difficulty breathing, swelling of the throat, and hives. The Epi pen allows for the patient to self administer the life saving drug Epinephrine. This medication cannot be given in a pill form it must be given thru an IV or injected into a muscle.

When taken Epinephrine can stop the spasm of the airway and allow patients to breathe. It can stop the swelling caused by the allergic reaction so hives will resolve and the throat won’t swell shut. It is truly a life saving drug. The beauty of the drug is it can be injected by anyone, the patient, a family member, a teacher whoever happens to be present and realize it may be needed. Laws are in place that allow schools to keep Epi Pens and use them without the fear of being sued, teachers are taught how to use them on a student who is having an allergic reaction and needs the medication now..

This is the drug that we have in our body for our fight or flight response. It allows our heart to pump harder and faster and allows us to breath deeper, exactly what we needed centuries ago to out run that bear. Adrenaline is produced in our adrenal glands which sit right on top of our kidneys. The side effects from the adrenaline in the Epi pen cause the patients heart to race just as our own adrenaline does when needed.

So why are we talking about this great life saving drug? Well recently the manufacture increased the price by $100, for many that got the price over $600 a dose. They raised the price as a generic product is set to come out soon. This is a common tactic as companies try to cash in before the competitors product hits the market. More interesting is that the drug does not have a patent, in fact when we talk about generic here we are talking about the delivery method not the medication.

This recent price change made some individuals take a look at the historic price change. Before we get into the price change lets talk about the drug and the cost to healthcare facilities. This drug is used in areas of the hospital and is important for cardiac cases, Allergic reactions in the Emergency room and for patients with uncontrolled asthma. Most schools now keep a supply of these on campus in case of a student with an allergic reaction forgets to bring their Epi Pen. For those who use the Epi pen it can be life saving. Unfortunately we are now hearing stories of patients not being able to afford it and unable to fill the prescription. This will only increase the chance of a devastating health outcome, increased use of medical facilities including the Emergency Room and in some cases having the patient admitted to the hospital. In simple terms, worse care and more expensive care.

If you look on line today you can find vials of epinephrine for $ 4.50 for a 1 ml vial. The amount of Epinephrine in an Epi pen is 0.3 ml and the cost is over $600 now, yet the pen carries about $1 worth of medication.. Yes, this is right. The vial has essentially enough for 3 doses and costs under $5, but the injector pen costs over $600. This price difference has had some individuals look into buying the vials and making their own injections, this unfortunately takes up to 1-2 min to do and that is time a bad allergic reaction will not allow for.

One company essentially has the monopoly on the Epi Pen, it is Mylan Labs. There are a few companies looking to get into the market for the Epi Pen, one is being reviewed currently by the FDA. The Epi Pen in 2007 was $57 dollars it is now up to $600 for for a package of 2. Needless to say the leadership at Mylan labs has come under fire. The CEO is heather Bresch, her father is a US Senator from West Virginia. The company has recently made some pricing concessions follow the recent outrage. They have set up a discount for individuals who meet certain financial thresholds. Hopefully this will allow those in need of this life saving drug access to it.