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ehrnst

(32,640 posts)
Wed Aug 24, 2016, 10:05 AM Aug 2016

The EpiPen, a Case Study in Health Care System Dysfunction

The EpiPen isn’t new; it has been in use since 1977. Research and development costs were recouped long ago. Nine years ago, it was bought by the pharmaceutical company Mylan, which then began to sell the device. When Mylan bought it, EpiPens cost about $57 each.

Few competitors existed, and for various reasons, that has remained the case. The device actually worked and saved lives. People needed it. Mylan raised the price. It also began to raise awareness.

The Adrenaclick, while still not cheap, is back and less expensive than the EpiPen. Some think it’s harder to use, though. It’s not on the accepted list for many health insurance plans. More important, few physicians think of it. Because of that, they write prescriptions for EpiPens. Since the Adrenaclick is not a generic version of the EpiPen, pharmacists can’t substitute one for the other. A prescription for an EpiPen must be filled with an EpiPen, regardless of what consumers might want.

Some people argue that we could still just use syringes and epinephrine for far less money. Sure, they would expire every few months. Sure, they would be harder to use and likelier to break. Sure, they would require training, be hard for the uninitiated to use in an emergency and be more likely to be administered with an incorrect dose. Nonetheless, you could argue that they’re an alternative when the “Cadillac” EpiPens are financially out of reach.

But those are unsatisfactory arguments. Epinephrine isn’t an elective medication. It doesn’t last, so people need to purchase the drug repeatedly. There’s little competition, but there are huge hurdles to enter the market, so a company can raise the price again and again with little pushback. The government encourages the product’s use, but makes no effort to control its cost. Insurance coverage shields some from the expense, allowing higher prices, but leaves those most at-risk most exposed to extreme out-of-pocket outlays. The poor are the most likely to consider going without because they can’t afford it.

EpiPens are a perfect example of a health care nightmare. They’re also just a typical example of the dysfunction of the American health care system.


http://www.nytimes.com/2016/08/24/upshot/the-epipen-a-case-study-in-health-care-system-dysfunction.html?smid=fb-share&_r=0


Fortunately Senator Amy Klobuchar (D-MN) called for the Senate Judiciary Committee and the Federal Trade Commission to investigate Mylan’s price-setting practices. Hopefully we will get more Senators to join her in fighting for affordable health care.
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TheDebbieDee

(11,119 posts)
1. I consider the Epi-pen price mess as
Wed Aug 24, 2016, 10:31 AM
Aug 2016

The main reason why governments should stay ready to get into the drug manufacturing business...

 

ehrnst

(32,640 posts)
2. Unfortunately at this point, bringing a new product to market will take time
Wed Aug 24, 2016, 10:34 AM
Aug 2016

I think that pricing controls will be more effective. The government is not in the business of manufacturing, and I'm not sure that it should be.

 

TheDebbieDee

(11,119 posts)
3. Yes, but the simple threat of government-produced
Wed Aug 24, 2016, 10:42 AM
Aug 2016

Meds may be enough to scare these gougers into being less greedy...

 

ehrnst

(32,640 posts)
5. They would know it's not possible - and would laugh.
Wed Aug 24, 2016, 11:11 AM
Aug 2016

They'd say, "People don't trust the government to provide health care coverage. You think they're going to trust the government to manufacture drugs? Way more people trust private industry than they do government."


Other countries don't manufacture drugs, but still get them more cheaply:

http://www.cnn.com/2015/09/28/health/us-pays-more-for-drugs/

 

TheDebbieDee

(11,119 posts)
11. Impossible? You've never heard of subcontracting?
Wed Aug 24, 2016, 03:51 PM
Aug 2016

The FDA could contract with a small pharm to produce the drug/meds and state the prices at which the meds would be distributed sold... The gov't wouldn't have to re-invent the wheel, it would just have to improve the way it works.

 

ehrnst

(32,640 posts)
12. That's not the government manufacturing drugs
Wed Aug 24, 2016, 07:52 PM
Aug 2016

That's just government purchasing drugs from a manufacturer. They already purchase drugs for VA hospitals and for the military.

They negotiate lower prices because they can buy in bulk.

There is just Pharma- not "Big" or ""small" pharma. Just companies, and lager companies can manufacture larger orders.

 

TheDebbieDee

(11,119 posts)
13. You're picking nits! The outsourcing situation I described has happened...
Wed Aug 24, 2016, 09:06 PM
Aug 2016

(the US Government subsidized the Polio vaccine manufacturing - they wanted to keep the prices low so EVERYONE could afford to be vaccinated) and this may need to recur with other vitally needed medications and vaccines... No matter what you call it or how it occurred, the US Government used taxpayer resources to cause medication/vaccines to be produced for public consumption in the interest of maintaining the public health.

CrispyQ

(36,457 posts)
4. This shit has to stop.
Wed Aug 24, 2016, 11:03 AM
Aug 2016
These setbacks, all in the last year, have once again left Mylan with a veritable run of the market. It raised the price of EpiPens again. As of this May, they cost more than $600 a pack. Since 2004, after adjusting for inflation, the price of EpiPens has risen more than 450 percent.


But your last raise was what, 3%?
 

ehrnst

(32,640 posts)
6. Hopefully anti-trust laws will force them to lower the price until
Wed Aug 24, 2016, 11:12 AM
Aug 2016

a generic can be tested and brought to market.

 

KittyWampus

(55,894 posts)
8. according to the article, there already is a generic but people don't trust it.
Wed Aug 24, 2016, 11:39 AM
Aug 2016

Epi-pen has been advertising on tv. They get name recognition and an assumption of superiority because of it.

 

ehrnst

(32,640 posts)
9. I think you misread:
Wed Aug 24, 2016, 11:58 AM
Aug 2016

"Teva had hoped to offer a generic version of the EpiPen, but concerns from the F.D.A. sent it back to the drawing board until at least next year."

 

KittyWampus

(55,894 posts)
10. I read the article in full this morning. There already is a generic antidote available
Wed Aug 24, 2016, 12:41 PM
Aug 2016

And it has its own auto-injector.

People are not being adequately informed.


http://acaai.org/resources/connect/letters-editor/letters-to-web-editor-6

mrmpa

(4,033 posts)
7. See my previous posts about the drug "Santyl"......
Wed Aug 24, 2016, 11:24 AM
Aug 2016
My 96 hour ordeal in getting a prescription for my 85 year old mom........

This past Friday I took my mom for an appointment at the wound care center. She has a large open wound on her leg caused by vascular disease, she is not diabetic.

The Doctor prescribed "Santyl" and faxed it to a pharmacy they say gets it for their patients at usually about $40. It's not a pharmacy that I would go to, it is locally owned and has a good reputation, but it is a bit out of the way. I checked the price on goodrx.com and found the lowest price about $212 @ the local Walmart Pharmacy. So I figured the $40 cost was of course utilizing a person's insurance.

Now my mom has Pacenet (A Pennsylvania program for seniors with a certain income). Now this insurance is $40 a month, with $8 copays for generic medications and $15 for name brand. I do not allow my mother to utilize the Pacenet as most of her medications are never more than $25 for a 3 month supply and Pacenet does not allow for a 3 month supply to be dispensed. Mom understands this and knows that Pacenet is only to be used when she needs a name brand and the cost is very high. Which in this case we will use it. The cost to mom should be $80 ($40 for insurance premium for January & February) and $15 for the medicine.

I go to the pharmacy on Saturday, give them mom's Pacenet card and learn that Pennsylvania does not cover medications from this manufacturer. Now understand there is only one manufacturer of this drug, world wide. As the Doctor wrote the prescription for a volume of 60, mom will need 2 tubes of this ointment, so now the cost at this drug store is $500 (though it will match the Wallmart price). However $424 is still something my mom can't afford.

I go home do my research & find that there is another drug "xenaderm" which is similar to "Santyl" but at 25% of the cost, $62. I called the Doctor's office on Monday and was told that "xenaderm" is an excellent substitute and they called the prescription into the Walmart Pharmacy. Closer to me and $62 is the goodrx.com price at Walmart.

I called Pacenet offices and learned that the manufacturer of "Santyl" refuses to participate in the Pacenet Program. They gave me the name of the company that makes "Santyl" and I called that company, it was recently bought by another company. I told the company service representative, Martha, that I was not happy that they would not work with the PA program and that they were forcing many seniors to pay for medication that was too costly for those on a very fixed income. I was very nice and informed her that I would be letting my State Senator know about the unwillingness of this manufacturer to work with Pennsylvania.

After I get off the phone with Martha, the Doctor's office calls us & tells us that Walmart is having difficulty finding "xenaderm". I call the local pharmacy and ask if they can locate it, they check their distributor and they can't find it. I then do my research and learn that the manufacturer of "xenaderm" is the same manufacturer of "santyl".

I called Martha back, left a voice mail and told her I need to have "xenaderm" available in Pennsylvania, so my mom can get it. Martha promptly called me back and informed me that they discontinued manufacturing "xenaderm". The light bulb went off in my head. I incredulously asked "so you discontinued the less expensive medication (the medication that gets better consumer ratings) in order to sell only the more expensive drug? I continued with comparing her company to the NYC exec who upped the price on the $1.50 pill to $750. I continued with and you have the audactity not to work with insurance programs run by States." I also informed her that not only will my State Senator get an email about this, but also my US Senator will.

I called Walmart and told them that I learned that "xenaderm" is discontinued by the manufacturer. The Tech was great, she said to give her a few minutes to look something up. She directed me to the Santyl.com web page, where there is a coupon worth $50 toward the purchase of "Santyl" and the company will pick up the next $150. I called the local pharmacy and told them what I had learned. The pharmacist told me they could take the coupon but it would be about $200, since mom needed 2 tubes. I said no, I'll take one tube today, $50, I'll pick up the 2nd tube next week, $50. And that's what I did.

Doctor's office called this morning & said she ordered something with the Home Health Care Agency. I told her to rescind that order, as I had taken care of the matter and "Santyl" was in the house.

This was an ordeal that no one should have to go through. I'm 59 and it was a headache for me, I just wonder how many people my mother's age, don't have an advocate and paid full price for this drug. Also I don't see the $150 the company pays for this drug as "corporate care, or corporate giving back". I think that the drug's real cost is far from $500, it's just a price they wanted to charge for it. They don't have to research it, as it was developed by the company they bought out. I think this company just sees an uptake in the need for this ointment and is trying to make a quick buck.

If I sound cynical, I'll admit that I am.

Follow up:
Update to my post last week: 96 hour ordeal of getting mom's prescription

Today I went to pick up the prescription of Santyl for mom. Last week we paid $60 after receiving a $150 discount from the drug company, and mom paying $60 ($50 + $10 over the $200 mark).

The pharmacist rings up the prescription and asks for $145. I said no, it was $60 with the discount last week (Monday the 15th). He goes to the computer checks and comes back and says the $145 is with the company paying $150. I said the drug can't go up $85-$90 in one week, he says yes it can.

I declined the medication had it transferred to Walmart, where I find the goodrx.com price to be $214.80. The coupon/discount will be $150, so mom's payment will be about $64.80.

I'm not in disbelief that a pharmaceutical company will up the price by $90 in one week, especially one that discontinued the generic/cheaper version of this salve. I've also found out that since 2013, the increase in prescriptions for Santyl is about 25%, which is a reason this company is doing this.

This is obscene.


Nye Bevan

(25,406 posts)
14. Patent protection for drugs should be conditional on no price gouging.
Wed Aug 24, 2016, 10:06 PM
Aug 2016

You want patent protection, fine, but you agree to keep the price at a reasonable level. You want to raise the price to ridiculous levels, you lose your patent protection.

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