The Cost of Living With Allergies
It costs the pharmaceutical giant Mylan $1.44 to manufacture a single dose of the anti-allergy epinephrine, but it costs consumers $600.
Opinion piece and photo: Moira Landvatter
“I drew you a picture.”
Two wide, hazel eyes are staring back at me. Those eyes belong to my 7-year-old cousin Juniper. She reaches up to give me a hug and I thank her before heading back to the Thanksgiving table. Everyone’s favorite dish is there, except for the nut-dusted cheeseball. If Juniper ate it, she would die. Her nut allergy is so severe she relies on the EpiPen, an epinephrine auto-injection used to treat anaphylactic shock.
Symptoms of anaphylactic shock are potentially life-threatening and include, “throat swelling, persistent wheezing, fainting, and low blood pressure,” according to the Centers for Disease Control and Prevention. Epinephrine, when injected, alleviates these symptoms by “improving breathing, increasing heart rate, and reducing swelling of the face, lips, and throat.”
Juniper tries to avoid nuts, but she always keeps her EpiPen on hand, just in case. However, paying for her EpiPen is getting increasingly difficult as time goes on. Mylan, the EpiPen manufacturer, raised the drug’s average price from $83 a decade ago to $600 in 2016, according to The American Journal of Medicine.
Despite these price increases, the EpiPen remains virtually unchanged since 2009, according to the American Medical Association.
Mylan owns both the brand name and generic version of the EpiPen, solidifying its monopoly of the epinephrine-auto-injection market and forcing my aunt and uncle to pay top dollar for a product that could save Juniper’s life.
And Juniper isn’t alone. Four to six percent of children in the United States suffer from food allergies, according to a study by the CDC.
“The concern is that some patients will forego purchasing the EpiPen and run the risk of not having the immediate life-saving treatment available in the rare case of needing it,” says Dr. Emily Gibson, medical director of Western’s Student Health Center.
EpiPens are not expensive to make. ACE Surgical Supply sells a 1mL dose of epinephrine without the plastic injection mechanism for $4.79. The adult EpiPen delivers an even smaller, 0.3 mL dose, according to a study done by the National Institutes of Health. Using these figures, one dose of epinephrine used for an EpiPen costs approximately $1.44.
The Food and Drug Administration is not at a loss for cheaper, generic versions of the EpiPen either. There are currently 4,036 backlogged applications waiting for FDA approval of generic products that could potentially save consumers hundreds of dollars, according to the FDA’s quarterly update released in July 2016.
Mylan is releasing a generic version of the EpiPen, at a 50 percent discount from the current sale price. A 50 percent decrease from $600 is still $300, a far cry from the original cost of the EpiPen, less than a decade ago. Even at a reduced cost, $300 is still too much for a life-saving medication, especially when the medication is so cheap to make. Efforts to reduce the cost of the EpiPen are a step in the right direction, but do not excuse Mylan’s actions.
Up to 15 million Americans have food allergies, according to a statement by Food Allergy Research & Education. These research findings also illuminate another striking statistic: “Every 3 minutes, a food allergy reaction sends someone to the emergency department; that is more than 200,000 emergency department visits per year.” These people rely on EpiPens to keep them alive.
“Something is very, very wrong when drug companies value their profits over the lives of their customers. It is time to enact prescription drug policies that work for everyone, not just the CEOs of the pharmaceutical industry,” Sen. Bernie Sanders tweeted on Aug. 24, 2016.
President Donald Trump agreed by stating in a January 2017 press conference that drug companies are “getting away with murder” when they dramatically raise their prices in a short period of time.
Mylan CEO Heather Bresch, in her September 2016 testimony to the U.S. House of Representatives Committee on Oversight and Government Reforms, claimed Mylan raised its price is due to increased access to the EpiPen, stating, “[Mylan] now reaches 80 percent more patients.” She also claimed there used to be “a lower awareness of anaphylaxis” and Mylan has brought awareness to the issue.
Mylan will soon release a version of the EpiPen with a longer shelf-life, so that consumers won’t need a refill as often, Bresch claimed.
That is the other problem with EpiPens. They expire. Consumers pay the astronomically high price and after 18 months, must pay it again, or risk that their product will not be effective.
“A common drug that needs replacing every year and has had such a big price increase affects the budgets of individuals and health care providers,” Gibson says.
In her testimony, Bresch failed to acknowledge her base salary increase, which went from $1.2 million in 2014 to $1.3 million in 2015 — an 8.5 percent increase, according to the U.S. Securities and Exchange Commission. And Bresch wasn’t the only Mylan executive to get a pay raise. Rajiv Malik, Mylan’s president, and Chief Commercial Officer Anthony Mauro also saw increased base salaries of 11.1 and 13.6 percent respectively.
Dr. Gibson says she doesn’t see the price of EpiPens coming down anytime soon.
“There will be alternative delivery systems that will be developed, at less expense, but they must go through the FDA approval process which can take years,” she says.
Nickel and diming consumers shouldn’t be the way Mylan pays for their executives’ already high salaries. Most consumers, whose lives rely on the EpiPens, can only dream of earning what Bresch and her colleagues earn.
My aunt and uncle are a middle-class family renting a house in Portland, Oregon where the cost of living has been steadily rising. My uncle is a technician who works on coffee machines. My aunt works as a part-time server at a restaurant and spends the rest of the time taking care of four children. They work hard to support their family, but companies like Mylan are making it increasingly difficult for them to do so.
Life-saving medications should not be out of reach for consumers, especially when there are simple ways to cut the costs of these medications. People like my aunt and uncle should not be forced to pay the extravagant salaries of pharmaceutical executives like Bresch.
I look down at the drawing Juniper drew for me. It’s a picture of our family — stick figures of her older sister Eliot and herself hold hands, standing in front of a house. I shudder to think what would happen if she was exposed to tree nuts and could no longer afford an EpiPen.
Whether it’s holding pharmaceutical giants accountable for their price hikes and lack of transparency or putting pressure on the FDA to approve more applications for generic alternatives, we owe it to people like Juniper to find more affordable options for American consumers.
After all, it’s a matter of life and death.