The EpiPen and What's Wrong with American Healthcare
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- เผยแพร่เมื่อ 21 ส.ค. 2024
- Three times in the last two weeks, people - a patient, a colleague and my wife - told me stories about how out of control the price of EpiPens were. Monday, my New York Times colleagues recounted in detail how expensive the devices have become in recent years. All tell the tale of how much even basic health care can cost in the United States.
But by digging a bit further, the story of EpiPens can also explain so much of what's wrong with our health care system. That's the topic of this week's Healthcare Triage.
This episode was adapted from a column Aaron wrote for The Upshot. Links to further reading and sources can be found there: www.nytimes.com...
John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics
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I purchased EpiPens a week or so before the price drop (paid over $500). My pharmacist called me because she remembered me complaining about the price. I took my receipt in and they were able to re-run my purchase and refund me $200. It's still ridiculously expensive in my opinion.
That's great service, nice pharmacist!
I want to send your pharmacist cookies!
I was walking out of the pharmacy today and this same pharmacist was on a poster for winning a corporate wide service award. Good for her!
Cost of passport (120$) cost of gaz to drive to Canada (100 to 200)$ Price of Epipens in Canada (99$)... Total price less than 500$...
With the lower price, it cost me $310. Driving to Canada would cost more not to mention is would be around a 20 hour round trip so I would need a hotel to stay overnight.
Epipen price in Belgium:
No prescription: €43
Prescription: €11.30
Orphan/widow(er): €6.11
I looked it up on the internet and from what i found here in germany you only get it with prescription but it only costs about 10€.
Prescriptions in the UK cost £8.40, however a prescription can have more than one unit of the medication. Personally my prescription is usually for 7 epipens at a time, thereby allowing each epipen to be slightly higher than a £1 each
Do you know how much is covered by subsidies? That is, is the price increase still relevant for EU just paid for by taxes or is it really cheaper?
+foobargorch we have universal healthcare so safe to say its payed by taxes.
Patrik Van Pee that much I assumed, I'm curious whether the Belgian government pays the same price as an American (or their insurance company, if any)
Since the mylan CEOs father is a senator, I wonder if anyone could believe he might have had a role in the FDA rejection of alternatives.
Joe Manchin and his daughter Heather Bresch. There are questions about her lying to congress about the price gouging of the epipen.
Diabetes is even worse. My Epipen, $370 for a Generic 2 pack. Humalog and Lantus insulin, costs $700 a month. Plus $150 of test strips a month
I just got a $12,000 insulin pump, now I need $500 of pump supplies, $150 test strips, and $350 insulin every month
Move to *Canada*
Drink every time he says "Mylan raised the price again."
Drink every time Mylan raises the price again.
What they neglected to mention was the connection to mylan and congress.......
The daughter of a democrat senator had a bill pushed through that had requirements that schools now stock epi pens. Then she raised the price.
epi pens are able to be purchased from overseas and from Canada for a fraction of the cost they sell down the street. same brand, same pen. cheaper even with shipping.
That would explain why the government not only fails to control cost, but succeeds in raising barriers to entry. I'd prefer to only fix the latter, but that's beside the point.
Martin Stringer
Ah senator, not congressman there ya go.
I wonder how easy it is to purchase epipens from canada as a U.S person. If you have, do share.
Senators are congressmen, congress is made of the Senate and the House of representatives in the USA.
epinephrin injections are a matter of life and death. i rather have the government controlling that market then having people die from bad epipen alternatives. i rather have the government only fix the first.
Locally in UK we are switching away from Epipen to Emerade. Epipen costs far less in UK than in the USA, the basic price to our NHS being Epipen 0.3mg x2 @ £52.90 ≈US $70.96. However the 3-year shelf-life of Emerade makes it a more cost effective option, although initial cost is slightly higher with Emerade 0.5mg x2 @ £57.48 ≈US $77.11. Emerade adheres to the Resuscitation Council's advised adult dose of 0.5mg, rather than Epipen idiosyncratically claiming only 0.3mg being needed, and has the longer needle length that is advised for adults thus ensuring the injection is placed deep enough to ensure proper delivery. Emerade delivers the drug faster than Epipen and is simpler to use (covering trigger-cap is same end that the needle emerges) whereas Epipen with its trigger guard being opposite end from the needle has resulted in some patients injecting their thumbs (which risks compromising blood flow to the thumb) or, worse, members of the public accidentally injecting themselves rather than the collapsed patient. So for those patients who need replacement of their Epipen because of its short 1-year shelf-life, Emerade works out to be about £19.16 ≈US $25.70 per annum for the NHS. Of course this cost is borne by our NHS, and the cost to patients is only the flat rate prescription charge of £8.40 ≈US$11.27 (just under 2% of what Americans have to pay for this), assuming they are not entirely exempt (children, fully time students to age 18, those over 60, and people on certain benefits).
Hah! I just read on arstechnica this:
On Tuesday, New York Attorney General Eric Schneiderman announced that his office is investigating Mylan Pharmaceuticals Inc, the maker of EpiPen, for potentially using anticompetitive terms in contracts it had with many school systems. Those terms allowed schools to receive Mylan’s EpiPens for free or at discounted prices-as long as they didn’t buy any competitors' products for a year.
They maybe have been doing illegal things!
MAY????
New York lawyers be like "Yeeeeesss, about to do what we do best!"
$600 a pack? Are you fucking kidding me? They're sold for £28 a pack to the NHS
Spend a few hundred thousand dollars convincing senators, congressmen, and regulators to shut down your competition and you can see a return in the tens of billions.
Don't you love it when the government "helps"?
Thanks for doing this. I've been watching for about two years now. This is one of my favorite series to watch. Please keep it up!
Meanwhile, EpiPens cost £85 in the UK or $130. That's not to be sneezed at, but that sure as hell is a more reasonable price
And about 40 in Australia
is that for a 2 pack or for a single pen?
twin pack in uk is £89
www.europapharmacy.co.uk/epipen
Is that what the NHS pays for them, or what it costs to acquire it privately?
Ralphie Raccoon
what it costs to get it privately with an NHS prescription, I'm guessing the NHS pays more
As an insured diabetic, I had been unaware until recent articles started hitting the news how much insulin prices had also increased in recent years since I just pay a set amount. My uninsured or poorly-insured diabetic brethren are getting royally screwed monthly.
It's appalling what pharmaceutical companies have been doing with regard to basic, life-saving drugs. Pricing life-savings drugs for their "value" rather than their cost long after their original patent terms have run out is immoral in my opinion. It begs the question of where the competition is in the pharmaceutical industry and just how much collusion there is in the marketplace. Seems like a lot of pharmaceutical companies get to operate near monopolies for high revenue drugs for years until a light gets shown on the abuse and then a bunch of companies make announcements about entering the market to provide "competition" that may or may not ever arrive. My impression is that once the issue dies down and attention goes elsewhere, so does a lot of the theoretical competition.
The FDA seems like the definition of regulatory capture.
I could tell that Aaron was reeeeaaaally pissed about this. Good for him!
Over $600 for an epipen is ridiculous. They cost $37 in Australia, so around $30 in usd under the pharmaceutical benefits scheme. How sad is it that we create drugs which save lives, but people can't afford it, and go without it. Honestly, the government needs to be able to reduce such a monopoly or have something similar to the pbs, and have prices set low for common drugs which many people need.
This is a good example of why I take issue with arguments about "what the market can bear."
Fun fact. As a pharmacist in Idaho as of July of this year, I have prescriptive authority over epinephrine auto injectors. So if there is a more cost effective alternative, I can use it.
Too bad not all 50 states & U.S. territories allow the same prescriptive authority for pharmacists.
Apparently I picked a good time to need this medicine. I just paid $22 after insurance. Pharmacist said that it was $100 without insurance!
My question is: Which Politicians/FDA bureacrats are Myelin's lobbyists paying off to maintain their monopoly and for how much.
Joe Manchin
Incredibly well-organized and informative episode.
One of the best since the early tour de force of national healthcare systems. I really like the investigate story telling over the general fact checking episodes but appreciated them both. Thanks
It is wholeheartedly heartbreaking that companies can continue to charge so much for necessary medications. It makes a job such as being a physician or any job in the health care field harder because all most of us want to do is take care of our patients but unfortunately, pharmaceutical companies and insurance companies continue to get in the way of fully fulfilling the care we desire to give. This also brings up the ethical issue of justice, where those who can afford it and have been provided a different life will be able to have access to expensive drugs and those who may not be as fortunate may have to live in fear constantly because they do not have the medication/healthcare that they need. I agree with the speaker in the video when he emphasizes that the poor population are most likely to go without this very necessary medication.
I keep thinking about a generic one-shot drug delivery device. A one-use needle cartridge at the front, a spring-loaded body, and a connection point for bottles at the back. You would preload it with epinephrine (or insulin, or other drugs), set the dosage, then add a cartridge. When it needs to be used, you'd simply use it like an epipen and then refresh the needle cartridge.
The issues around dose consistency and sanitation abound, though, and it'd be tough to bring to market. On the other hand, it could save some lives, and likely be built for very low cost.
The military issues atropine (for chemical warfare) in a self contained squeezable tube with a needle for emergency self administration when in potential combat areas. Why couldn't someone create and sell the same system - oh, I forgot the FDA is limited by Congress who obey their contributors and one of the senators is the father of the CEO
We already have something similar for insulin -- it comes in "pens" with screw-on disposable needles that let you dial in a precise dose and will not deliver more than you request. The problem with insulin is that it needs to be refrigerated, doses vary WIDELY between individuals, and need for insulin is rarely urgent (except in severe cases, hyperglycemia is dangerous in the long term, not the short term -- and if glucose pills aren't handy to treat hypoglycemia, juice, soda, and candy are usually nearby just about everywhere).
And I thought selling drugs on the street got people rich, who knew doing it the legal way would get you way richer.
As a healthcare major and a caring citizen, I believe that everyone should be able to afford medication. With the rising prices of Epi Pens, Mylan's motives seemed to be based on profits instead of patients. The government seemed to also be giving Mylan a reason to raise the price; for example, selling two Epi Pens in one dose. When realizing that people need more than one Epi Pen and that the pens need to be replaced yearly, the Mylan company has no need to raise their prices. There is always a demand for Epi Pens. When lower class families cannot afford necessities like life-saving drugs, their lives are put in danger. It just makes sense to me to have a healthier country by making drugs available to everyone in every financial situation.
I’ve never watched the Healthcare Triage videos on youtube, but I am very glad that I got to watch a couple today. These videos are very educational and a good insight into the world of healthcare. The use of the topics of epipens is just one example of how our health care system in America is charging its citizens way more money than necessary to get the medicine we need to survive. There are a large number of people in this nation that need epinephrine to put their allergic reactions to an end, but if it is too expensive, how will they be able to get it? And if they cant get it then what are they going to do when they have an allergic reaction to it and don't have their epipen to give them epinephrine to open up their airway?
Epinephrine is a very cheap medicine it costs less than a dollar per millimeter, and there is less than a third of that in an epipen. Because of the way that the drug needs to be administered most of the costs of the was the packaging. When the company Mylan bought the epipen the whole cost to buy one was about fifty-seven dollars. The whole supply and demand of the product resulted in the price being raised again and again, because lets face it you need it so you have to buy it. Plus you need them for everywhere you might be the you have the allergic reaction and you need new ones every year so that they are not to expire. This becomes hundreds of dollars that is being spend every year just because you might have an allergic reaction. As of May 2016 a two pack of epipens are more than six hundred dollars, that is completely outrageous. The fact that our healthcare systems and the leading companies within it, like Mylan, think that they can rack up those prices and screw the consumers over. We need those medicines, and it’s bankrupting the majority of us to the point where we can’t even buy the medicines we need to keep us alive.
Schools with nurses should be fine with the epinephrine/syringe combination. It's what we use on ALS ambulances.
In Poland they cost something around 50$ for a pack and for some people with special prescriptions it's even cheaper ~ 15$. And you can also find some alternatives as cheap as 10$...
The cost for an EpiPen now is outrageous. It blows my mind that they would make you pay that much for something that some people need to save their life. But now a days that is what our healthcare system has come to and it seems as if drug companies are flat out just taking advantage of their customers. They know that an EpiPen is something that is NEEDED so therefore they are going to charge a bunch of money for it because they know people will still have to buy it. I have a friend who is deathly allergic to bees and needed to buy a new EpiPen that costed her $600!! I was in shock when she told me how much it was. There's no way it should cost that much and this is a serious issue that needs to be addressed more!
why do they make them so expensive? because they can. Because some people believe in "free market economy" in which they believe that they should have the freedom to extort sick people, because 'Murrica & freedom and such.
Exactly how do you define a government enforced monopoly on the production of EpiPens as a "free market?"
streglof - Any decent person would demand this be stopped, as it's the exact opposite of "Freedom and such". Besides, it's not a "free market" if said market is monopolozed, thus your statement is formally fallacious.
you already can buy them from china for peanuts
but do you really trust china not to fuck it up and potentially kill you?
Mack or Mick The "government monopoly" is a result of patent law and intellectual property rights, without which innovation becomes pointless. A free market without patent law stifles innovation. Maybe patent law needs reforming.
According to FARE, anaphylaxis isn't just the airways swelling. It can present in other ways too. There's gastrointestinal anaphylaxis too, which really sucks in case you were wondering.
As a previous user of Epipens, this situation hits close to home. Mylan almost has a monopoly on this life-saving drug dispenser, which has saved my life in the past after an extreme allergic reaction to a bee string. This company is taking complete advantage of the 1-2% of the population that needs their product and, at least in the United States, there is no one defending this minority. It's also unfortunate that the combination of doctors not being well enough versed in medication alternatives and the patents that Mylan has on these dispensers limits the competition to almost non-existence. If this price hike had happened before I had needed the device, I may not have had one available and probably would have died. I am thankful that there have been some price drops in the last month, but medication prices should be regulated more by our government and companies like Mylan should not have any ties to Congress and the politicians that run it.
As a European, thats just crazy!
Here in Germany you pay when prescribed 9,41 € (= 10,33 US-Dollar) per Pen.
Here insurance companys push for low prices of pharmacuticals etc.
(We have to admit, that you have to pay about 15% of your income for insurance.)
Price in France : 69,13. 65% of which is paid back to you by the gouvernment, so 24,20. Plus, if you have even bad private insurance, you'll get it for free ! (for context, I pay 14 euros a month in private health insurance, didn't pay a cent for 1 year of physio, a back operation, and medication).
My brother is allergic to all types of fish and must have an EpiPen on him at all times, which is why I clicked on this video on the first place. I can attest to the monopoly Mylan has on the market after watching my parents shell out hundreds of dollars each time he needs to replace his EpiPen. In an ethical sense, I believe the issue of beneficence should be the biggest concern. A quick definition of beneficence is that there is moral obligation to act for the benefit of others. There is no reason that the price of EpiPens has raised over 450% since 2004 other than the fact that it is easy to use and demanded by a large group of people. I feel that Mylan and/or our government has an obligation to set a price that people can actually afford. Instead, people such as my brother are spending large sums of money just to keep anaphylaxis from killing him.
I know a few people that rely on EpiPens in the summer in case of a bee sting. As more and more people started to need EpiPens they raised the price of them. Which caused some people to be unable to afford them. It costs very little to make these pens so why do you need to raise the price? Its just so the company can make more money and make a bigger profit off of them. This is very unfair to the people that rely on these pens to save their lives in emergency situations. These pens have an expatriation date and need to be replaced every year. When they first came out the price was $57 now they are over $600. The government encourages the products use but makes little to no effort to control the products cost.
EpiPens are needed for several reasons, but the prices are outrageous. The fact that Mylan keeps finding ways to up the prices and make profit is crazy. For something that cost so little to make, they sure cost a lot to purchase. I've never had to use an EpiPen so I was not aware of how much they really were. As of this year, it cost about $600 to get them per pack, which is unheard of! The government encourages these policies as well, which correlates to exactly what's wrong with America's healthcare system.
We are quite lucky in India. We don't really have auto injectors, but a 1ml vile of epinephrine costs only Rs13, that's roughly 17 cents. The markup is incredible in the US.
It is ethically defunct of America to charge astronomical prices for healthcare at all, but lifesaving medication? Three things should never be mined for profit: education, prisons,&healthcare.
I like how you gloss over the FDA blocking competition from entering the market as if it were nothing more than a footnote. Totally not biased or anything....
I think the cost of medication and physician assistance is outrageous so the title of this video really caught my attention. Both my mother and I are allergic to bee stings and while mine is not as severe of an allergy as hers is, it has been recommended to us by our doctors to purchase an EpiPen and carry one around constantly. Both of us objected that though because we, at the time, did not feel as though it was a necessary precaution to take because we live in Michigan and bees are only prevalent for 3 months out of the year at best and as adults with fulltime jobs, are not outside frequently enough to be stung regularly. What was never brought to our attention though is that Epinephrine, the drug inside of the EpiPen, expires and replacement is constantly needed. My doctor also never discussed my other options with me for other Epinephrine dosing options, she simply said that it could end me up in anaphylaxis shock and I could be hospitalized if I didn’t seek treatment within a timely fashion of being stung.
I thought that monopolies were illegal in America though and I thought that there was somebody out there that had a close watch on what company drove out other competitors. It sure seems as though Mylan has a tight hold on the market and is only being enabled to continue their tight hold on said market. The cost of the EpiPen started at fifty seven dollars in 1977 and has since skyrocketed to over four hundred dollars. That is crazy. Fifty seven dollars is a whole lot more affordable than four hundred plus dollars is. I think that something so many people require to not die should be affordable too. It needs to be replaced at least yearly and has the potential to save somebody from dying, those two factors alone are enough to lower the cost of Epinephrine in my opinion.
I totally agree. I had an economics class last semester in college and we went over the inflation rates, costs, etc. of the Epipen. It is absolutely ridiculous how much the pricehas risen over the years. When I had econ. last semester, the Epipe was priced six hundred dollars for a two pack of pens. I also find it ridiculous how you have to replace them so often. Allergic reactions aren't things that happen everyday, you never reallyknow when you'll need the Epipen. Some people could go all year without needing to use an Epipen, but as soon as the pen expires, that's when it's needed the most. There are about 29 million americans today without health insurance, and those with insurance can't get enough coverage to be able to replace and Epipen every year.
As a school bus driver in Oregon, what sucks is that the Oregon Department of Education does not support drivers directly administering EpiPens and insulin injections. What ODE supports is getting the device ready and in the patient's hand so that they may administer it.
Most allergic reactions can often be treated by the use of diphenhydramine (Benadryl), but sometimes if someone is severely allergic enough to a food or insect bites, anaphylaxis can set in. This happens in about 1-2% of allergic reactions. Anaphylaxis is when the airway starts to swells and close making it near impossible to breathe. There is a simple reversal drug to anaphylaxis, it is Epinephrine. It is a hormone produced naturally in the adrenal glands. It is also a very cheap drug, it costs about one dollar for a milliliter and there is less than a third of that in a regular EpiPen. But, in order to save a person’s life, Epinephrine has to be administered quickly and in the correct dosage. Drawing the drug into a syringe and then administering it correctly requires training that many people lack, and even if you are trained if an emergency occurs your adrenaline kicks in and it seems like skill and training is sometimes thrown out the window. Thus the birth of EpiPens. They have been available since 1977. And nine year ago, EpiPen was bought by the pharmaceutical company, Mylan. They raised the prices of a single EpiPen to $57 each. It is also proven that EpiPens do not have a long shelf life and expire after about a year, causing users to have to get replacements frequently and that means more money for Mylan. Due to its degrading qualities, using an expired EpiPen is not recommended. Epinephrine always needs to be delivered in a full dose, and if its expired, you could be less than the recommended dosage. Every year, it seems that Mylan raises the prices and recently have been selling them in packs of two only and not individually. In 2012, two competitor’s versions were discontinued and in 2013 a version came out that had an auto voice that came on and gave specific instructions to the administer. This was quickly recalled due to giving improper dosages. A generic version is in the works, but isn’t set to hit the shelves until next year.
More recently, in May of 2016, a 2 pack of EpiPen auto-injector cost $600. This is a 450% increase in price since 2004. An alternative still exists, it is not cheap but it is less than the EpiPen, its called the Adrenaclick. Physicians rarely prescribe this because it is often forgotten about, and since the Adrenaclick is not technically a generic version, pharmacists cannot substitute it for a prescription written for EpiPen. A prescription for an EpiPen has to be filled by one. And this is unfortunate for users because Epinephrine is not an elective medication. It doesn’t last and needs to be replaced over time and there are no other options. This is especially upsetting for the poor or people living in poverty because they cannot afford such a drug and elect to take the risk of anaphylaxis. This is just an example of the dysfunctional American healthcare system.
This pen is a lifesaver and it needs to be fairly available
The fact that it's even legal for Mylan to raise their prices virtually indiscriminately is one of the biggest problems with our healthcare system..
As a person with a fairly new food allergy with a stupidly severe food allergy (I got a reaction from salad once because of cross contamination), the price hike on EpiPens sucks balls. And I need to refill my prescription in a couple of months. $600 sucks, and I don't want to pay it. But I'd rather pay $600 than die.
I remember in 2009 I could get epipens for like $60 a pen. I’m deadly allergic to peanuts and having to pay $500+ a year for two epipens is ridiculous
Thankfully my anaphylactic allergies can be easily avoided (drugs and shellfish), so I no longer need an epipen. I feel bad for sufferers of unavoidable allergies.
I agree with the statements that John Green makes in this video. The exponentially increasing prices of the EpiPen violate many ethical principals such as patient autonomy, justice and the doctrines of beneficence and maleficence. Additionally, questions should be raised about Mylan allowing patients to contract with them by purchasing the EpiPen despite the fact that patient decisions may not be fully informed on account of pharmaceutical companies or regulatory agencies withholding information about alternative options to the over-priced but necessary EpiPen.
Patient autonomy is the ability for patients to make their own decisions, free of coercion or external influence.
Patient autonomy is compromised in this situation because information regarding alternative treatments and the true cost of the EpiPen, both the market value and production value, are being withheld yet Mylan is still engaging in contract with patients who have not made informed decisions. To that extent, patients do not believe they have a choice because the EpiPen is potentially life-saving and viewed as a necessary sacrifice. But is it necessary to sacrifice outrageous amounts of money for something when there may be another way? Not necessarily, but patients would never know otherwise because they are not being adequately informed. This brings up the concept of justice, the idea that all persons should be treated fairly and equally. There are people who have no problem paying full price to protect their lives but is it right to raise prices knowing that people will pay no matter what? Consider those people who are unable to afford the drug and cannot pay. Are they any less deserving of life-saving treatment? Absolutely not, but Mylan seems to believe so.
Finally, Mylan is violating the doctrines of beneficence and maleficence. They compromise beneficence because they are not outwardly doing any good by withholding or making it difficult for at-risk patients to access the EpiPen, yet they have the ability to be doing so. By making it difficult to feasibly access the product, they are putting a greater burden, both psychological and physical, on these patients and the healthcare systems that ultimately care for them. The drug companies are acting unethically by failing to promote health despite adequate and ample means to do so. Maleficence, acting in a manner that harms a patient, is clearly seen in this case as well. Pharmaceutical companies are malicious in the way that they hold patients hostage with high prices for basic drugs necessary to sustain life. Knowingly doing so for the sake of making money is immoral and should not be the standard of care.
In summary, it is clear that Mylan is blatantly violating many ethical principles, but can these violations be extended and applied to the FDA or other agencies such as insurance companies that are allowing such egregious offenses to persist unchecked? I would say yes, Mylan is not the only unethical player in this cycle of corruption.
Just looked it up. Belgium. The normal price for one EpiPen in the farmacy is 43,60 €. People who are covered by the Belgian healthcare system pay of that 6,75 € or 11,36€ depending of your income. $ 600 is insane.
Which is equivalent to $51.38
Honestly we need more chemists like me who DONT work for major companies who own everything they create to come together to create generic solutions to destroy pharma companies. They're WORSE than any cartell or street gang.
"And Mylan raised the price..." Why do we allow companies to maintain monopoly control over life-saving medicines? Some other company could manufacture the device if there weren't patent protections in place. I'm glad we have insurance to pay for the sets of EpiPens we need each year for my kid.
How would they prevent it? The company doesn't have an enforced monopoly; they're just the only company making the product. This is why healthcare should not be covered by the private sector. At least, not entirely; making a profit for pharmaceutical companies and insurance companies and the public good are not in any way aligned.
I was arguing specifically against the patent protection. I think the patent should no longer be valid. It has been enforced long enough for the original patent holders to make back their investment.
I honor Jonas Salk who refused to patent the polio vaccine because that kind of protection should 'belong to the world'. Honor has become extinct in robber baron capitalism.
So, here's an interesting side of this whole debacle: I work for a home infusion pharmacy that provides IV, subcutaneous, and complicated IM treatments for patients at home (to get them out of expensive hospitals where their risk of secondary infections is often higher). New protocols require all solumedrol (methylprednisolone) IV patients to have an epipen (not an anaphylaxis kit which contains a vial of epinepherine, among other things, for the home health nurse to administer in the case of an allergic reaction) on hand for every dose.
Unfortunately, most insurances won't cover an epipen in that instance, since they argue that the epinepherine vial should be sufficient and many medical insurances (what we primarily bill as opposed to pharmaceutical insurances) don't cover it at all. We used to provide the epipens to our patients free of charge since it was much more cost effective for the pharmacy to take on the solumedrol patient and bill their main drug and nursing to insurance, which almost never costs the patient anything since they've reached their out of pocket maximum from hospital stays and specialist visits before they ever reach our intake department.
Now, though, having to give a patient a free epipen (pharmacy wholesale cost of over $500) far outways any reimbursement we might get for the solumedrol and nursing. We have actually had to turn patients away and send them back to the hospital for a periodic treatment (often short term every 2 weeks or so) because we can't afford to take them with a free epipen and the patient can't afford to purchase one on their own.
Mylan is taking advantage of the EpiPens being (basically) the only Epinephrine on the market. Physicians write prescriptions for their patients no matter how rich/poor they are. Poor patients cannot afford to buy EpiPens every year. $600 for 2 EpiPens seem way over priced in our current market. I believe that if Mylan can keep increasing the price of EpiPens, then the patient's insurance should cover more than half of the bill. An EpiPen can save someone's life and no one should have to pay over $100 for it.
The biggest reason that this is an issue is that EpiPens involve a medication that patients who have severe anaphylaxis to specific medications cannot go without due to the risk of death. Although the pharmaceutical companies have a right to make a profit, the ethical relevance of a patient's right to life-saving medications should take precedence. Unfortunately, this is not an easy fix. As the video discussed, there have been several attempts by other manufacturers to produce a similar medication. Even AdrenaClick, which some providers have since taken to prescribing, is not truly an affordable option, although more so in comparison to the ever rising prices of the EpiPen. It is likely that at some point in the future this will involve a lawsuit after a patient dies from an anaphylactic reaction after not being able to afford their medication, however ideally we should come up with a better solution prior to something this drastic occurring. It will be interesting to see how effective pre-filled syringes may be on patient outcomes in the future, although it sounds like this solution is currently farther out than we have time for. The most realistic option would be for another pharmaceutical company to come up with a more efficient generic mechanism to replace the EpiPen, and force Mylan to reconsider their outrageous prices. Additionally, it might be time for the government to step up and force some additional regulations given the serious health risk associated with inaccessibility to this medication.
Could you do an episode on biotin and like drugs that claim to increase hair/growth. I'd like to know if it's a waste of money or not.
I actually hope this channel steers clear of cosmetics.
+saturnday oh no biotin is orally ingested and an episode on it would be way more akin to vitamins (bc they too are orally ingested in hopes of improving/maintaining health) than it would be to a topical product like makeup that has no claims of improving skin quality. Also, curious, why would you not want a video on makeup specifically?
I just for a moment imagined this channel turning into "the 35 best beauty products you haven't heard of" and it scared me a little. I already kinda think that vanity is wasting more than it's share of humanity's effort.
Biotin is something naturally found in foods etc, so taking it is more of a way to fill the gaps that you miss out on in your diet rather than boost the amounts in your body and get your hair to grow etc if that makes sense? Most vitamins cannot be stored, so we excrete the excess in urine, sweat, poo, whatever. If you're already getting enough, it isn't going to do anything. If not, it probably will help just because your body needed it and you weren't providing it. So, (like all vitamins) there's no way someone could tell you if it's a waste of money or not because it depends on your own body. Same with the hairfinity crap, it's mostly biotin anyways. If it helps, great, if not, that's also great because you're eating well. You can log your meals into a website called cronometer to see how you're doing with that and all your other nutrients. It could be a protein thing, an iron thing, there are so many Reasons to have slow hair grow or breakage. If it's really bad or out of nowhere
You gotta ask your doctor
This is kind of akin to the whole Daraprim mess with Martin Shkreli a few years back. But, I am wondering, how many people in the States have no form of healthcare, how many kids suffer from anaphylaxis, and how large is the overlap in that Venn Diagram?
They're not trying to recoup the cost of developing Epipen, they're charging $500+ for "future development of drugs" and for CEO pay.
Of course, when Congress passes legislation mandating an emergency stash of something supplied by only a few firms, we should not be surprised that the market suddenly tolerates a higher price for the higher demanded quantity.
Why don't they just allow intracardiac injections. It'd mean a lower dose and a quicker onset of action. It's not like it's hard. Just go four ribs down and your there.
The increase in price for EpiPens is very unfair to low income families and individuals. While it is quite easy to demand a higher price when it is a necessary emergency medication without competitors, it does not make such a high price increase correct when the price for epinephrine is less than a dollar per milliliter. When in anaphylactic shock, the person does not have time or the option to go without an immediate response, in this case the only option is an EpiPen. It is necessary that a person that may have a severe allergic reaction be prepared in the case of contact with their allergen. This often means, especially for children, having multiple EpiPens. For example, a child at my daycare has an EpiPen in each of the following locations: her preschool classroom, our daycare room, her home, and her parents home. With a two pack of EpiPens costing approximately six hundred dollars, her life saving medication amounts to twelve hundred dollars, a price that must be paid each year so the medication does not expire. While some may not bat an eye at such an amount, most American families cannot afford to pay such an amount. Yes, insurance may cover these causes but that is not often the case. Therefore, low income families are faced to make a decision on their child's life that they cannot afford to make. While it is easy for the producers of EpiPens to continually raise up prices, it is crucial that they do what is best for their consumers and make their life saving products affordable to all income groups.
The fact that companies can raise their prices with no rhyme or reason is one of the BIGGEST problems in healthcare today. When and where does it stop. I understand medications that are harder to come by, have a lesser need for, or even that aren't used often having a higher cost. But the epi-pen? Shame on Mylan as well as our government for allowing this to happen. I know this is not the only medicine this has happened to also. There are so many people out there that need the epi-pen. And it's not like people choose to have life threatening allergies that make them need this medication. I am curious, how much, if any does an insurance company cover? But that still does not make it right when not everyone even has health insurance. The government needs to take control of this situation because we know Mylan is not the first and will not be the last to take advantage of the need for their medication. No one on this planet should have to go without an epi-pen if they need it. In most cases and forms birth control is free, so why can't epi-pens? Personally, I value the need of an epi-pen more than I do birth control. Epi-pens should be accessible at a low cost, to all people who have a written prescription for them. Especially since they noted that the cost of epinephrine is very low. It should be downright illegal for things like this to happen in our modern day healthcare system.
Thanks for these videos.
According to Wikipedia, "a silicon valley engineering consultancy" did a tear down of an EpiPen and estimated cost of production at $10. So as much as we in the UK and similar countries can sit smug about our relative lack of price gouging it seems no country's system is getting these devices at less than a multi-100% profit rate from these gangsters Mylan. The US is merely in the 1000s range
My problem with health care and the EpiPen is how it has become so
expensive. It seems as though they are taking advantage of this fact because
$500 for an EpiPen is just outrageous to me, especially since only two pens
come in the pack. If I had an allergic I would use a different type of medicine
such as Benadryl, which works pretty well for me, bur for other that might not
work because they reaction may be too serious and need something stronger such
as the EpiPen. I believe this will affect health care in today’s society
because they are making medications harder to get by rising the prices. The health
care nation is trying to get more money instead of helping people health, that
is what’s wrong with health care today.”
4:20 "Teva had hoped to offer a generic version of the Epipen, but concerns of the FDA sent it back at least until next year."
You could have summirized the whole video in this one sentence, honestly. It isn't expensive because corporations are evil, corporations are just maximizing their profits, that's what they do. The reason it's expensive is because there is no competition, because of government regulations and patents. This is the same as every other drug or device or medical care in America. Engineering is easy, any company can make an Epipen, but dealing with government isn't.
This points out the effects of any government created monopoly, which are especially evident in the US healthcare system. Any monopoly in any field is going to raise its price to where its profits are maximized. And the FDA routinely grants monopolies.
In most other countries, the government will set the price. Of course, they can do that, because in most cases the US has already foot the bill for development costs, and the other countries only pay for the marginal cost of production. In effect, the US is paying for the world's drug development.
Solutions to this problem are easy to figure out, ranging from government price controls on monopoly drugs, to limiting the length of the monopoly. But this is a very arcane issue, and I know of no group or association advocating for it. OTOH, drug companies are very well aware of the issue, and lobby Congress incessantly.
wouldn't you think that huge deregulation by the government would also solve the problem? in any industry with little regulation, the free market system lowers price and increases quality.
The real question is why aren't insurance companies more than willing to shoulder the cost when the alternative is a $20,000+ ambulance bill?
In Canada, 1 epipen costs about 78 USD and the price has been stable since 2007, because it's not Mylen that distributes it, but a subsidiary of Pfizer's.
This is legally a case of breaking anti-trust laws, but ethically it is one of conflict of interest, one that can be traced right to the top of Mylan. The CEO of Mylan during this drastic rise in the price of EpiPen has been Heather Bresch and according to NBC news from 2007 to 2015 during the time that the EpiPen retail cost rose 461%, while her salary increased by 671%. On the surface this seems a clear case of a monopoly, and possibly price gouging, but it is much more complex and possibly calculated. Heather Bresch just so happens to be the daughter of Sen. Joe Manchin, whom in 2007 was the Governor of West Virginia. Joe Manchin’s wife is Gayle Manchin. Gayle is on the West Virginia State Board of Education, which is an appointed position. Gayle was appointed to that position by her husband, the then Governor of West Virginia for a nine year term in 2007. While on the board, Gayle used her position to lobby for Mylan’s "EpiPen4Schools” program which gave away EpiPens to schools and promoted the idea that schools need to purchase EpiPens. These campaigns then lead to “Eleven states drafted laws requiring epinephrine auto-injectors. Nearly every other state recommended schools stock them after what the White House called the ‘EpiPen Law’ in 2013 gave funding preference to those that did,” according to USA today.
www.usatoday.com/story/news/politics/2016/09/20/family-matters-epipens-had-help-getting-schools-manchin-bresch/90435218/
But what are pharmaceutical corporations’ ethical obligations? Is it to the patients that the medications are being sold to? Is it to the taxpayers, or is it to the corporate stockholders? Because pharmaceuticals are a part of the medical system of care I believe that they should be held to the same ethical standards as doctor and nurses, and not those of profiteering corporations. Aaron Carroll points out that the recoupment for the cost of research and development (R&D) for this particular drug has long been met, and the profit margin well exceeds the norm, but that is not the problem. It is apparent the profits from this price hike wasn’t reinvested in further R&D, it was pocketed by this CEO. The problem is that Mylan’s CEO used the influence of her parents political positions for personal monetary gain on the taxpayers’ dime and at the expense of patients who need this lifesaving drug. This is a clear conflict of interest, in my opinion.
I used to carry an Epipen, not because I needed it, but because someone else might. Sadly I can no longer do that.
I got an Epi Pen Canada ad on this
Indonesia have a price at about 52 bucks non prescription. Which is still very expensive in this country's standard but still not a kidney's worth like whatever the US got. If a considered developing country have it way cheaper than you, you know something's wrong
FDA: "Buy 2 EpiPens"
Suffocating child: "cough* Regulatory Capture *cough*
Overall, the cost of EpiPens has risen outrageously since they first derived. People across the world develop all types of allergies, some of which depend on the EpiPen for survival. An EpiPen would be needed when the allergic reaction is so severe that it sends the person into an anaphylactic shock. People don’t get to choose if they develop an allergy to something, or how severe their allergy may be. Sometimes two EpiPens aren’t enough, and people, especially children, need them in multiple places. For just a 2 pack of EpiPens, it costs $600. That’s devoting over $1000 on every child that needs more than two for the places that they go and need to have them. It’s sad to see that some families don’t have EpiPens for the person that needs them simply because they can’t afford it. After learning that Epinephrine costs less than one dollar per milliliter and how much Mylan raised their prices after having sold so many EpiPens, it is heartbreaking to know that some people can’t afford to buy an EpiPen because of the fact that two EpiPens have to be bought rather than just one. The price of EpiPens should be lowered since the number of cases of allergic reactions rose significantly over the years. Mylan appears to only be worried about the profit they are making off of EpiPens. Instead, Mylan should be worried about a person’s health and realize how beneficial an EpiPen can be to a person.
This whole story about the EpiPen is a prime example of why our healthcare system in the United States is terrible. Like the video said, only one company makes EpiPen and that's Mylan. They have raises the price of an EpiPen almost every year. Of course nobody in the American healthcare system is going to put a stop to this because that's just more money in their pocket. They don't care about the patients who have to pay more out of pocket for an EpiPen now then they've ever had too. The biggest shock was that it was the American healthcare system who was the one that mandated that an EpiPen should be sold in packs of two instead of one because some children weren't getting enough epinephrine from one EpiPen so people should be better safe than sorry. I feel like that wasn't the real reason why the mandated that the EpiPen come in packs of two. The real reason is probably because the healthcare system probably just wanted to make more money from the sales of EpiPen through Mylan. It's crazy how the American healthcare system works. You have to pay so much money to protect yourself and keep yourself alive. So many people have allergies and need an EpiPen just to be safe. It's just another way for the American government and healthcare system to rack in more money from people.
Is it really that difficult for a company to develop a competing product?
Regulatory Capture. Strict Prescription Rules. Patent Protection. Regulations and Time to Market. Insurance masking the message of price. Legislating preference of a product. Legislation reducing options on insurance.
Yep, those are the problems with medical devices in general and the rest of the US healthcare system... Government Involvement... NOT CORPORATIONS.
Fortunately we don't have this issue in Canada because the price is regulated. I've heard you can by Canadian Epipens for a much reduced cost and have them shipped to you however. Don't know the specifics though.
In the UK you can buy the two pack for like £85. It's still ridiculously over-costed but why is it so much less than the US? Worst-case, can't you order them online and get them shipped?
Glad I live in the UK with a free on charge system and cheaper pepipens . And if it is not too rude too ask, I was also wondering if you could do a episode on British Doctors strike. If would be nice to see a US doctors perspective. All the best!
The EpiPen really shows the flaws in our Healthcare system. One company holds the only real answer to someone experiencing anaphylactic shock. This control allows Mylan to charge an outrageous amount of money, when Epinephrine should coast less than a dollar per person. The government does not interfere with these types of monopolies. which only encouraging the problem to get worse. The worst part about all of this is people are suffering. EpiPens are vital to anyone with an allergy. The idea of providing medicine to people who need it should be more about healing rather than income. Many people do not feel the effects of Mylan's increases. However, there is a large group of people who do feel it, the lower class feels these increases hard. If you do not have insurance, you'd be lucky to afford one at most. Not to mention they only have a year shelf live. One is also not enough. An allergic reaction could happen anywhere at anytime and some may not be prepared with only one EpiPen. The way our government allows pharmaceutical companies to continually increase prices to absurd amounts needs to be stop. Lives are at stake and income should take the back burner.
what he seems to be saying is that anytime an alternate is created the government steps in with regulations that stop the results. We've been trying to fight the business owner all this time when the government and their regulations are really the ones to blame.
America needs someone like Margrethe Vestager.
Competition isn't some panacea that corrects corporate misbehavior. There's tons of profits to be stolen, pried, and wheedled out of niche markets, and there's not enough marketshare for a competitor to jump in.
Guess what the advertisement pre-ceeding this episode was? Epipen Canada!
Why won't a competing drug maker duplicate EpiPen's pen design? Surely any patent on it would have expired by now if its original release was in 1977?
1-2% of people can develop anaphylaxis. This is deadly, where the persons' airways can close and the person will be unable to breathe. EpiPen is easy to us and has been used since 1977. People soon began to use EpiPens for even prevention, rather than to stop the reaction. This made manufacturers include 2 in a package, and raise the price. I am confused on why they are to keep raising the prices. Instead of creating a monopoly off of them, these should be manufactured at a quicker pace, using more advanced technology. If we were able to find a way to easily and cheaply make these items, they would be able to lower the price. The price for these should not be made to the point where people with allergies are not able to buy the medicine they need because the prices continue to rise. I agree with the writer, America is supporting monopolies for medicine and it needs to be stopped. Our economy is not being supported properly, and it should not be used this way when it comes to health care.
My problem is not with the free market. It is figuring out why and fixing what is wrong not having the government fix nothing and just make everyone pay. In some universal system that solves nothing.
I saved a couple hundred dollars by buying another brand (not sure what it is) but I guess it's tip doesn't withdraw after use so you have to be careful not to poke yourself after you use it. I'm not sure how my parents found out about it, but they had to drive to a different pharmacy kinda far away I think. Hopefully I'll never have to find out if it works or not.
The cost of EpiPens is ridiculous especially because it helps with allergic reactions. An EpiPen is so easy to use and give just the right amount of epinephrine to the child/adult that needs it. I do believe that you should replace your EpiPens each year. The cost of EpiPens are quite expensive and not many people want to buy them because of the cost, so people try to find other ways of using epinephrine. Some people buy them now because they need them right away just in case something happens. EpiPens are very important and the people that are poor cannot afford what they cost now and so they do not buy them. What if something happens to their child? Then what do they do? It is not fair to raise the price because now not everyone can afford them and so they go without them and that is not a good thing.
I absolutely agree. The safety and convenience of having an epi pen should be available to all those who are at risk of anaphylaxis. Insurance companies should never make their customers go through obstacles for something like this. I mean, it's not the same as asking to cover something cosmetic like lasik eye surgery or breast implants, etc. It's for something completely legit. From a deontological standpoint, the insurance companies along with the makers for epi pens dramatically increasing the prices of their products, they are failing the people that need them the most. Their job is to make these medicines to improve the health of society, not make them struggle for it. There's so many people that will constantly be buying or using these pens so they're still making money off of it regardless. Think about it. If epinephrine is less than a dollar per milliliter, then the prices are mainly coming from the auto-injector and the other substances that make up the medicine. It all comes down to greed for money.
How much training do you actually need to do an emergency injection? A 5 minute training video? A day long course (Like CPR Cert Class)? More?
At one of my old jobs a coworker needed an insulin injection and had gone too long without it so he was all weak and shaking and unable to really speak clearly or walk easily. His kit was back in the truck and he told me he was going to pass out before I got back with it, so just follow the directions on the box and do the injection. The directions consisted of a stick figure showing you how to draw the stuff from the little bottle and where to inject it, literally two pictures and probably 12 words. It was easy, he woke up just in time for the EMTs to reach us.
I am all for the auto-injectors, I'm just curious how much training the syringe method requires. Did I get lucky and just do it right? I mean, the guy lived and was back to work the next day, so... Success?
When there's such a monopoly in other markets, doesn't the government force that one company to split? Why won't they do that with Mylan?
There are almost no reasons I would harm another human being. I wouldent think twice if I met those responsible.
The amount of money for an EpiPen is literally ridiculous and makes it impossible to have a constant supply of them. This drug has a life that is about a year a time. But every time they updated the EpiPen prices keep increasing and increasing. This drug costs practically nothing and companies are selling it like it’s the fountain of youth. Many people have allergic reactions to many odd and bizarre. Yet even more are allergic to thing like peanuts that is prevalent all over in today's world. So the cost of an EpiPen could be immeasurable compared to someone who is allergic to a kangaroo for example. Purchasing something that costs 600 dollars per unit and you use them often you could become bankrupt in no time and problem at all. There are other options but the EpiPen is the easiest to use, the other drug requires a lot of training and skill to use making it difficult for the public to use unless you were trained to use is.
It's extremely unfortunate that this device that can very well save someone's life is so difficult for everyday American's to get their hands on. I think that this is a case of drug companies taking advantage of their customers. Personally, my dad is deathly allergic to bees and for awhile, he used to carry an Epipen. There are more inconveniences to them than just the skyrocketing prices. My dad travels a lot for work, and he would always have trouble storing his pen because you aren't able to leave it in the car or let it get above/below a certain temperature. Aside from that, you are responsible for replacing your Epipen every year or so when they expire. Not only is the first time cost utterly outrageous, but it's completely inconceivable for one to plan on spending that much each year on an Epipen that they may or may not use. When we have access to such a life saving tool, it's a shame that it can't be more readily and easily available for those who could benefit from epinephrine in live-threatening emergencies. My dad no longer carries an Epipen because of the unreasonable prices.
Krystal, I’m sorry to hear that your dad can no longer carry an EpiPen because of how expensive it is. First, I’d like to point out that you and your family, unfortunately, are not the only families who have been impacted. I also use an EpiPen. Unlike a majority of society, I am fortunate enough to have extremely good health insurance, so I do not personally see the impact it has. Companies like the EpiPen company are starting to draw many ethical questions. The biggest ethical question here is whether or not something so cheap to make should be sold at such an expensive cost when it is highly needed among the community to save lives. I understand the companies want to make a profit but not everyone can afford these unreasonable prices. The companies have a duty to the community to allow those in need to get the proper care they need. Those who cannot afford expensive EpiPens may try to go without and will not receive the proper care. Also, EpiPens should be sold in a single pack. Making them available in only a 2-pack will increase the price and limits the amount of people that could possibly receive treatment. Utilitarians would argue that raising the prices of EpiPens for personal gain is unethical because it does not help the greater community. On the other hand, others would argue that it’s unethical because it’s the companies duty to themselves to lower the cost because it’s the right thing to do. Again, I am sorry to hear that your father is one of the many impacted by this.
There is a generic for mylans Epipen, at least my pharmacist gave one to me. AuviQ is also back I believe.
I can't believe that these guys are able to put this high of a price on a medicine that so many people need in order for them to survive an allergic reaction. Especially since the medicine that they use is at such a low price per milliliter so why raise prices? So many people are going to have to go without especially the poor because they can't afford it. Everyone should be able to afford the medicines that they need especially if it's going to save their lives.
Twin pack in Canada is 240$ , still more affordable than the US
thanks man
your videos helped me study and helped me with my project 👍
Dam $600 is ridiculous its only $100 if you get it without a script in Australia and $37.30 when you get it with a prescription. The american system is really messed when it comes to private medications should have more government backing for a single payer system.
Why is there not a generic version of the EpiPen? The original patent should be expired by now and the drug is cheap and outside of patent so no one else wants to make a generic at half this exorbitant price?