By Sue Hubbard, M.D.
I have more than several patients who have had serious allergic reactions (anaphylaxis) to a variety of things, including insects (fire ants, bees) as well as foods (peanuts, tree nuts, fruits, shellfish). All of these children need to have epinephrine auto injectable pens (an EpiPen) on hand in case of “accidental” exposure to the allergen and a subsequent life threatening allergic reaction. These medical devices are seldom used (thank goodness), but need to be replaced every 12 to 24 months and should always be readily available in case of an emergency.
For the longest time, it was not a “big” issue (cost wise) to write prescriptions for these allergic children and to make sure that they had several EpiPens on hand. This included having them available at home, at school, in the mother’s purse, in the car or in the gym bag. Many people also wanted “extras” to have at the grandparents’ house or at the lake house, for example. So, I would write a script for the EpiPen two-pack and the family might get four to five sets to disperse to the appropriate people. Prior to 2009, the cost was less than $100 per two-pack.
It was several years ago that a few families started talking to me about the expense of these devices and also how quickly they seemed to expire. In fact, we started asking the pharmacist to look at the expiration dates and to try and dispense the ones that had the longest expiration in hopes of saving some expense. At that time, there were also two companies that were making the epinephrine devices.
Then, in the last, year parents started calling me complaining that the EpiPens were becoming cost prohibitive and asked if they really need to keep filling them sinc they had never needed to use one. Thankfully, because of their vigilance, they had not needed to use an EpiPen, but I told them that YES, they indeed needed to continue to have them on hand. Several families reduced the number that they bought and tried to make sure that they handed them off to their child if they left the house, which is terribly hard (I would think) to keep up with.
This issue came into view most recently as parents across the country started complaining to not only their physicians, but to the pharmacy, their insurers and the drug maker, Mylan Pharmaceuticals, asking, “Why in the world has the price jumped to more than $600?” In retrospect, the price had been raised 15 percent twice a year over the past two years! (It was also pointed out that this was a six-fold price increase in the past decade).
I do know that epinephrine has been around for a long time, the drug itself is not that expensive, and it is used every day in hospitals around the country. But the EpiPen auto injector, which allows “anyone” to inject the medicine into a muscle without any measuring, has become cost prohibitive for many families, even some those with insurance. It seems that Mylan Pharma is setting prices “based on whatever the market may bear” and not on the fact that the drug is new or expensive to produce.
This is one of the times that all parents with children who need to carry an EpiPen need to contact their representatives in Congress, as well as their insurers, to see if the public can be influential in trying to remedy this situation. The public will have to let their concerns and voices be heard.
Just as I am writing this, Mylan announced an “instant savings card” for those who are paying out of pocket plus help for those who do not have the means to buy the EpiPen. But this does not correct the problem as a whole. While the discount may be helpful for some, it is not the answer to the ever-growing problem of exorbitant drug costs in this country.
(Dr. Sue Hubbard is an award-winning pediatrician, medical editor and media host. “The Kid’s Doctor” TV feature can be seen on more than 90 stations across the U.S. Submit questions at http://www.kidsdr.com. The Kid’s Doctor e-book, “Tattoos to Texting: Parenting Today’s Teen,” is now available from Amazon and other e-book vendors.)
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