19 ms·

EpiPen Price Rise Sparks Concern for Allergy Sufferers

224 points by helloworld 10y ago

helloworld 10y ago
Why haven't competitors entered the market with cheaper products?
- FLUX-YOU 10y ago
  Patent on the injection system I believe
- blackguardx 10y ago
  It isn't a free market. There are significant barriers to entry for medical products.
- pg_is_a_butt 10y ago
  because you're all cowards, and the justice department takes money from the companies who are leveraging a medical survival need to generate profits for a private company who built themselves on grants and research paid with public money.
- serge2k 10y ago
  > Last year, the drug maker Sanofi recalled a competing product, Auvi-Q, because it may not have been delivering the correct amount of epinephrine, leaving the EpiPen as the primary emergency treatment for severe allergic reactions.
  - JunkDNA 10y ago
    To all the folks in this thread suggesting 3D printing and all sorts of other ideas, keep in mind that Sanofi is not some fly-by-night or scrappy startup. They are a major pharmaceutical company with decades of experience manufacturing pharmaceuticals and the quality control that is required and even they couldn't get it right. They actually had a very innovative product. It was much smaller than the EpiPen and used voice prompts to tell you how to administer the drug (people in the heat of the moment sometimes don't remember to leave the EpiPen in long enough for a proper dose to be fully administered). I'm frankly mystified how they botched things so badly that they had to pull the product.
    - snowwrestler 10y ago
      I have to wonder how well expertise in pharmaceutical manufacturing really translates into expertise in manufacturing an auto-injector. The hard part of the EpiPen is not the drug, it's the mechanics.
- Animats 10y ago
  They did. Windgap[1] took venture capital, took state funding from Massachusetts back in 2012, and didn't ship the product. Cool web site, though. Sanofi tried, but their product misfired at least 26 times and was recalled.[2] Teva tried, and their product was rejected by the FDA because of problems; they're going to try again with a new model in 2017.[3] [1] http://www.windgapmedical.com/ http://www.windgapmedical.com/ [2] https://www.auvi-q.com/ https://www.auvi-q.com/ [3] http://www.fiercepharma.com/sales-and-marketing/fda-swats-down-teva-s-epipen-copy-putting-mylan-cruise-control http://www.fiercepharma.com/sales-and-marketing/fda-swats-do...
  - leereeves 10y ago
    Three companies tried and failed? It sounds like it's harder than we might think to make this work. Given that, and the low volumes, it might not be that profitable even at $600 per sale.
    - ViViDboarder 10y ago
      But that R&D was spent years ago.
      - leereeves 10y ago
        I meant for a new entrant.
    - Animats 10y ago
      The companies that tried to enter the business were drug companies, not device companies. No expertise in volume manufacturing of medical-grade injection-molded plastic devices. There are companies which can do that.[1] There are automatic inspection technologies which can detect even minor flaws.[2] But the typical injection molding vendor isn't that good. Consider the typical failure rate of ball-point pens. That's consumer-grade injection molding. [1] http://www.advancedmt.com/wp-content/uploads/2012/10/amt_medicalsyringe_CS.pdf http://www.advancedmt.com/wp-content/uploads/2012/10/amt_med... [2] http://www.vision-systems.com/articles/print/volume-9/issue-8/features/industrial-automation/automated-inspection-station-rejects-defects.html http://www.vision-systems.com/articles/print/volume-9/issue-...
- refurb 10y ago
  They have, the products weren't up to snuff and were recalled.
- ccleve 10y ago
  There are really two villains here, Mylan, of course, but more importantly, the FDA. FDA regulations make the cost of bringing a new medical device to the market absurd. There are no competitors because the time and effort to bring a competing device is so ridiculously high that it doesn't pay to do so. I have a child with a peanut allergy. I am worried every damn day of my life. I see articles about people who die every year because they didn't have an Epipen handy. The numbers of people who die will increase. I want to see FDA bureaucrats hauled to those funerals so they can see what they've done.
  - RockyMcNuts 10y ago
    hmmh... what's the reg, specifically? what I see is an unholy alliance between the regulators and industry to extract max profits. if you don't have an approving authority for e.g. Epipens, it seems to be that you get something like the supplements industry which is mostly marketing and exploiting the ignorant. you need some IP protection for the crazy amount of incredibly skilled R&D and massive testing that goes into an Epipen but this is ridiculous. drug and medical device companies merge for maximum market power vs. insurers, who try to merge for maximum market power against drug companies and doctors/hospitals. eventually you'll have just one insurer and one drug company and one hospital company and you can nationalize the whole thing. just kidding, but I see Obamacare failing if it can't evolve, prices continuing to go up, and eventually everyone demanding a single-payer solution.
    - Spooky23 10y ago
      Obamacare is driving regional healthcare provider consolidation as well as insurer consolidation. As drug innovation has slowed, single payer US healthcare will be the solution to these problems. Nationalize some/all of the provider networks and drugs like this become built to spec government bids where buying power drives cost down.
  - dfsegoat 10y ago
    So, The FDA, because they require drug and device makers to demonstrate efficacy and safety by going through a rigorous clinical trial process, are evil? Really? I also find your comment pretty uninformed considering that the FDA just paved the way for generic drug makers to basically "knock-off" super expensive biologic drugs like Humira and Enbrel which were previously covered by similar patents. The FDA has it's problems - but to say that it is an agency staffed by people who don't care ("bureaucrats") who typically have both Ph.D and M.D.s and have dedicated their careers to ensure patients have safe and effective medicine is unfair. edit: grammar.
- jevinskie 10y ago
  I'm confused about this myself. I used to receive EpiPen brand auto-injectors. At some point, I started receiving Lineage Therapeutics auto-injectors (supposedly an Adrenaclick generic) instead. According to [0] they are _not_ equivalent to EpiPens according to the FDA. I'm not sure if my primary care physician or my old pharmacist (CVS chain) are at fault for not informing me of the differences. My generic prescription costs me, with insurance, $15 for two 0.3 mg autoinjectors. Insurance has covered four twin auto-injector packs (8 individual auto-injectors total) without any hassle. Either way, I have trained and informed myself on the proper use of the generic Adrenaclick auto-injector. From what I gather, the main differences are that there are two safety covers on both sides of the injector (instead of a cover on just the non-needle side) and the method of determining whether a dose was supposedly administered correctly (mainly, the EpiPen's needle cover is extended vs just observing an extended needle on the Adrenaclick). I am left to presume that their therapeutic effectiveness is the same, even though the FDA may not explicitly declare it as so. I will consult my physician and current pharmacist (local, non-chain pharmacy with excellent focus on patient care) to determine if I have any misunderstandings. I have also trained the people most likely to administer epinephrine to myself (family, friends, coworkers) the particular procedures of Adrenaclick administration, so I am not too worried about procedural differences between EpiPens and my generic auto-injector. Still, I am left wondering what the therapeutic difference between an EpiPen and a generic Adrenaclick alternative really is. I do understand that different administration procedures are a problem for training, but I would expect the actual therapeutic effects of both auto-injectors to be similar --- if used administered according to directions. [0]: http://www.pharmacytimes.com/p2p/p2pepinephrine-0910 http://www.pharmacytimes.com/p2p/p2pepinephrine-0910
  - stan_rogers 10y ago
    They're not equivalent (that is, it can't be freely substituted by a dispenser) only because the devices are mechanically different. Knowing how to use an EpiPen doesn't mean knowing how to use an Adrenaclick, even if they are aministering the same drug in the same dose using more-or-less the same kind of mechanism. It's that "more-or-less" that's the key; since they differ in the way they're used and administration is quite time-sensitive, you can't assume that a person trained to use an EpiPen will be able to use an Adrenaclick properly when the time comes (or vice versa).
- ec109685 10y ago
  The epi pen wasn't extremely expensive until recently, so competitors had to take a different and riskier angle to make it in the market. Perhaps now a carbon copy will do well.
deleted 10y ago
[deleted]
serge2k 10y ago
Well you know, they need to recoup the R&D costs to develop the drug. > Mylan, the pharmaceutical company, acquired the decades-old product in 2007, when pharmacies paid less than $100 for a two-pen set Oh. This is why US health care is broken people.
- kasey_junk 10y ago
  This is one reason. Another reason is that a huge chunk of the population will simply not see these costs. For instance, I choose to be on a high deductible plan at my work (they offer both a high deductible plan and a traditional PPO). My wife has the choice of a reasonably priced HMO and a extremely expensive PPO. On my high deductible plan if I need a refill for an epipen I pay the full boat unless I'm past my deductible (or really my HSA does) on my wifes HMO plan we pay $25 every time we need one. We both have prescriptions, what is the rational decision for my family to make if we need a new epipen? That cost differences is not "free money", it comes out of the pocket of my wife's employer and peers rather than my employer and peers. There is a dramatic agency problem in the US health system as well.
  - maxerickson 10y ago
    Apparently they'll cover your copay. https://www.epipen.com/en/copay-offer https://www.epipen.com/en/copay-offer (I didn't read it closely, but the eligibility criteria seem to be 'private insurance')
    - kasey_junk 10y ago
      I don't have a copay on epipens, but I do have a deductible. This actually can help me but the max is $100 off of full price (a few years ago I got $75 off with a similar card).
      - maxerickson 10y ago
        Oh, I didn't think you would be terribly concerned about the savings, I thought the company helping patients use their insurance was a nice addendum to your comment about the agency problem. Edit: The way I read it, if you give the card to the pharmacy, the company will pay the $25 on your wife's plan.
hoodoof 10y ago
Mylan refers the press to their local politicians "go talk to them about it, we pay our lobbying fees to get whoever we want elected specifically so we can charge any price we want, you can't do a damn thing - it's a free country".
- deleted 10y ago
  [deleted]
eliben 10y ago
If the product is decades-old, why haven't generic variants appeared? Something seems to be missing from this article.
- sriram_sun 10y ago
  There are generics. What is patented is the delivery mechanism. I've had to administer it twice. You take the cap off and just push it into the thigh. The top part moves back and the needle pushes through.
  - eliben 10y ago
    Thanks, so this is the missing information. The article misleadingly says the medication is decades-old, where actually the pen itself is patented.
    - toomuchtodo 10y ago
      The patent is expired: https://www.google.com/patents/US4031893 https://www.google.com/patents/US4031893 Courtesy ceejayoz below: https://news.ycombinator.com/item?id=12340464 https://news.ycombinator.com/item?id=12340464
      - shanacarp 10y ago
        so why aren't there more case manufactures
        Sanddancer 10y ago
        Because there's no equivalent of the bioequivalence study that generic drugs go through. Even if it's an exact copy, making a generic medical device means you have to go through the same entire approval process that the original went through.
        tw04 10y ago
        For the same reason there were no competitors to daraprim before Martin Shkreli decided to be a complete ja. When the price is low enough that there's little profit to be had, nobody bothers competing because it's not worth the time, money, and effort to get FDA approval. When the price gets jacked up like that, you will find generics pop up quickly. The problem is the window between the price hike and when generics pop up can sometimes be years due to needing to get FDA approval. In this case there was a competitor, but they recently had their product pulled from the market in an FDA recall. So Mylan decided: why not raise the price 600% (and rising) when it's a drug people HAVE to have. Capitalism in action baby. Let's deregulate EVERYTHING!
Mandatum 10y ago
They don't produce EpiPen's as a generic in India because the Indian medical community does not recommend self-administration of epinephrine. If you're that much in need though, you can buy pre-filled epinephrine syringes for intramuscular injection - just keep in mind the ease-of-use of an EpiPen won't be available. You have to take the time to take off the cap, insert and inject the medicine.
- shanacarp 10y ago
  what happens if someone goes into anaphylaxis?
  - Mandatum 10y ago
    I assume they intramuscularly inject epinephrine just as you would with an EpiPen. I doubt it'd be hard for patients to get hold of an epinephrine kit. You'll also find developing countries have far less allergic population. It's said this is partly due to urban environments having more vitamin D deficiency as well as people being more exposed to more pathogens/etc during childhood outside of developed countries.
tomohawk 10y ago
The US is subsidizing the rest of the world. When Canada decrees that the price of something will by X, then guess who pays?
- otterley 10y ago
  For example, an EpiPen costs $79 US ($99 AUD) in Australia.
  - ceejayoz 10y ago
    That's about what it cost in the US until recently. It's a decades-old generic med, the patent on the delivery device is long expired (https://www.google.com/patents/US4031893 https://www.google.com/patents/US4031893), and the original research was even done by the US military.
    - jonahx 10y ago
      so how is this insurance company getting away with what they're doing? you'd think someone else would produce it, sell it for <$100, and people would just buy them out of pocket. what stops that?
      - serge2k 10y ago
        Other companies don't sell them. They bailed for various reasons, and the expense of getting in just isn't worth it. If you develop an EpiPen and it costs you a bunch of money then in theory you can make it up by selling more volume. Except your competitor can just cut the price because they are already selling for an absurd amount of money, so how do you win now? Maybe we should have a non-profit that does generic versions, and we can subsidize it by preferring them to companies like this (e.g. all medicare provided drugs now go through this company which sells generics). Unless the companies are willing to match prices.
      - ceejayoz 10y ago
        > so how is this insurance company getting away with what they're doing? It's not the insurance company, it's the drug company. The insurance companies are probably livid about the extra costs they're having to cover. The answer to "how" is a variety of different techniques, including changing the formulation slightly (http://www.nytimes.com/2014/09/16/business/new-york-files-antitrust-suit-against-maker-of-alzheimers-drug.html http://www.nytimes.com/2014/09/16/business/new-york-files-an...) and outright bribery of competitors (https://www.washingtonpost.com/opinions/pay-to-delay-pharmaceutical-deals-smack-of-illegal-collusion/2013/03/24/f787f0da-9338-11e2-8ea1-956c94b6b5b9_story.html https://www.washingtonpost.com/opinions/pay-to-delay-pharmac...).
gmisra 10y ago
One of the early on-line responses was "maybe we can figure out how to 3D print these cases". It turns out that an Epi-pen is just a plastic safety housing around a normal syringe. Some discussions: https://www.reddit.com/r/news/comments/4y5481/cost_of_epipen_continues_to_rise_putting_burden/d6lao38 https://www.reddit.com/r/news/comments/4y5481/cost_of_epipen... https://www.reddit.com/r/3Dprinting/comments/4y7f26/epipen_fork_of_the_enable_project/d6lmoaf https://www.reddit.com/r/3Dprinting/comments/4y7f26/epipen_f...
- Cyph0n 10y ago
  That second discussion got heated quite fast. I agree with the downvoters though. 3D printing a medical device is not something to take lightly. Edit: Here's why I agree. You download this design from the internet, and 3D print the parts. You then assemble it. Awesome! Some time later, you get an allergic reaction. You use the pen, but it fails to work correctly. Who's responsible? The designer? You (if you're alive)? The printer manufacturer? Your friend who emailed you the design? etc. There's a reason why even getting such a simple design considered for FDA approval and certified for use on live humans is such a long and complex process. It's easy to make something that works some of the time, but it's extremely hard to make it work essentially every time, especially in life-or-death scenarios. Of course, the price hike is terrible and the company behind it deserves punishment, but that doesn't make it OK to endanger the lives of people.
  - toomuchtodo 10y ago
    Scarcity demands innovation. I don't think its being taken lightly; more like, "a private company is gouging medical users and the government won't step in". Not left with many options when your life depends on it. EDIT: Alternatively, a "better" temporary solution would be to arrange for the import of these from Canada, where the price is fixed by the government.
    - bobdole1234 10y ago
      Not so much fixed as "Canada doesn't insist that everyone make separate deals so everyone can get fucked harder". It turns out when you have millions of people dealing together as a block, they have much more bargaining power.
sevenless 10y ago
How many people will this price hike kill? I'm sure that's estimable. What would be morally justified, to stop it?
- rdtsc 10y ago
  Nah because it would upset the free market. I mentioned in another comment when someone from Europe or Canada asked something to the effect of "how come everything has to be free market in US even healthcare and such". And I think the answer is we treat free market as a religion. We don't evaluate what is better, healthier, more rational answer for a problem. Like say, "How do we keep people from dying from anaphylaxis?" We don't answer that. We always answer first, what would free market want? Will it want us to do this? If not, we don't proceed. We treat it as if it is deity of sorts and if we disobey we'll be punished. Someone replied and said this idea isn't so outrageous because a similar concept has been defined already in politics: American Civil Religion (https://en.wikipedia.org/wiki/American_civil_religion https://en.wikipedia.org/wiki/American_civil_religion) I am just proposing there is a similar religion in respect to free market. It is often sold in propaganda terms of course -- we are not communists here, we just want efficiency, we want progress, don't worry stuff will trickle down eventually and so on. So we make it palatable but the main incentive is worshiping the deity. It sounds crazy but evaluating a lot of things we do as a society through that perspective can be interesting.
  - schmidty 10y ago
    How is government protecting a monopoly free market exactly?
    - MarkPNeyer 10y ago
      EXACTLY A free market would mean anyone who wanted to to create one of these.
    - rdtsc 10y ago
      Why is it protecting a monopoly? Why doesn't it say "this EpiPen can't cost more than $30"?
deleted 10y ago
[deleted]
shanacarp 10y ago
This is one of those devices that also should be low cost because businesses, locations, ect should have them as well as individuals (many people can have first time deadly allergic reactions, including as adults) That the price for the case is expensive just rose as random is serious business. There really is no need for it to be so expensive
- robryk 10y ago
  What would be the layman-evaluatable criteria for using it on a person with no history of allergy?
- slowmovintarget 10y ago
  I have no evidence, but this headline coupled with the insulin price hike... it really feels like this is an attempt to manufacture a crisis. I fill a prescription for epi-pens once a year (nut allergies), but insurance bears the brunt of the cost.
  - gwright 10y ago
    Insurance simply distributes the high cost to many people via higher premiums. Without competition to reduce the cost or regulations that set the price by law, the high cost remains.
    - ancap 10y ago
      >or regulations that set the price by law, the high cost remains It is important to note that even such a law does not magically remove the high cost. Certain products have a high price for a reason and setting the price by fiat is guaranteed to cause shortages. That's when people really start dying. See Venezuela for a prime current example.
      - gwright 10y ago
        This is a very important point! If the fiat price is below the market price, then you are correct, shortages (or simply no product at all) are the result. If it is above the market price then the surplus is captured by the seller rather than retained by the buyer.
gkanai 10y ago
This is a simple example of how health care systems should be nationalized. Or that the profit motive in health care is corrosive to health.
- ucaetano 10y ago
  No it doesn't. Switzerland has one of the best healthcare systems in the world, which is completely private (although there are some public hospitals), but heavily regulated.
  - leereeves 10y ago
    Heavily regulated to avoid the corrosive effect of the profit motive? You two might actually agree.
    - ucaetano 10y ago
      On that yes, in some industries a race to the bottom or winner-takes-it-all is actually bad for society, healthcare is one example. My issue is not with the "profit" part, but the "health care systems should be nationalized" part.
  - robryk 10y ago
    Alas, there are significant differences between the Swiss and US one. Most importantly, law in Switzerland specifies exact coverage criteria for basic health insurance and prohibits excluding pre-existing conditions from it. I'm not sure how financing of hospitals works exactly (I was under the impression that they are at least partially publicly owned). Minor things: there are phone-a-doctor public services that are free of charge for residents in some areas. Edit: also, every company that provides basic insurance can vary the price based on a limited set of factors and must accept any person.
    - maxerickson 10y ago
      The ACA standardized basic health insurance and prohibited excluding pre-existing conditions.
xnor 10y ago
If people don't want to buy two epipen there's always that neat trick for multiple doses in precarious locations far from hospitals. It is a well known hack taught in wilderness medicine training. https://www.youtube.com/watch?v=luultUD0eK0 https://www.youtube.com/watch?v=luultUD0eK0
- gradstudent 10y ago
  If you have something concrete to say then say it. You're only lowering the quality of the conversation by making vague assertions in the style of "one weird trick" followed by mystery links to random places on the web.
  - jevinskie 10y ago
    This "one weird trick" may save your life if you experience anaphylactic shock and do not have multiple auto-injectors available, for whatever reason (cost, some have expired, remote location, etc). I discovered this technique a couple of years ago and was interested in it. I tried replicating the use with some expired autoinjectors. As far as delivering subsequent doses, I was able to reliably deliver 2+ more doses (into oranges) from my expired injectors. I feel better prepared for an emergency now. I have never needed to use my autoinjector. I had one incident where I was very close to shooting up my thigh but the symptoms were just "mild" enough that I did not. I met another person with severe food allergies at THOTCON this year who described to me in detail two separate incidences where he felt it was necessary to administer two doses. I hadn't really given much thought to multiple doses before hearing his stories (one of which included a medically induced coma). Now I make sure to have at least two doses on hand. My doctor certainly didn't express to me the potentially dire necessity of multiple doses! Of course, this bushcraft advice doesn't hamper my cautiousness about having autoinjectors around everywhere I may need them. I have a pair at my home, my office, my parents home, and my backpack (always with me when I travel). Eight autoinjectors, that need scheduled replacement, is a luxury I can afford. Others may not be so lucky and may be helped by these bushcraft techniques. I do need to research the issue more though because my insurance currently covers eight autoinjectors (not EpiPen brand, but a "generic"? Lineage Therapeutics brand [0]) at the rate of $15 per two 0.3 mg injectors. I'm not sure if I'm lucky, have great insurance, or what. [0]: http://www.epinephrineautoinject.com http://www.epinephrineautoinject.com
ohitsdom 10y ago
The petition to Congress mentioned in the article: http://www.petition2congress.com/20720/stop-epipen-price-gouging/ http://www.petition2congress.com/20720/stop-epipen-price-gou...
nilved 10y ago
This seems less damming to me considering the medicine naturally occurs inside your body. What reason is there that nobody else can make a competing product for cheaper?
- infinite8s 10y ago
  Regulatory hurdles to get a new device approved.
  - nilved 10y ago
    Maybe regulation is not so good after all
    - rtkwe 10y ago
      There was a competitor but it wasn't able to reliably inject the correct amount of medicine so it was recalled. [0] [0] http://www.fiercepharma.com/marketing/sanofi-s-auvi-q-recall-puts-mylan-s-rival-epipen-full-control-of-blockbuster-market http://www.fiercepharma.com/marketing/sanofi-s-auvi-q-recall...
- pkaye 10y ago
  The drug patent has long expired. It is an autoinjection mechanism that is patented. There have been many competitors in the market but some got recalled due to flaws.
- tdy721 10y ago
  I think the naturally occurring part is irrelevant. I mean it's not plutonium. Lots of interesting and unknown things are right under our noses, I don't believe that should change the value of them. The rest of your question is great, but it's a legal one, I'm no help there...
kabdib 10y ago
If your kid is allergic and needs an EpiPen (or something like it), most school districts will not allow the child to attend class unless they have one at the school. Maybe two. And of course you have to carry them. There's another two. So that's $2400. Out of pocket if you don't have insurance, or if your insurance doesn't pay. The EpiPen manufacturers are abusing their monopoly.
- Mandatum 10y ago
  Given the proper age, teaching kids to use syringe/vials or having a school nurse that can administer epinephrine would be a much cheaper alternative. EpiPens are purely about the delivery mechanism. Stabbing a syringe into your thigh and injecting a predetermined amount of epinephrine into your leg isn't majorly complicated. Maybe having a single pen on the kid and vials/syringes at the school would be a cheaper option.
  - jevinskie 10y ago
    I've never used an auto-injector on myself before. I have used expired auto-injectors on oranges and potatoes to make sure that I have a "real feel" for how the hypodermic needle really injects. The trainer injectors certainly don't teach you what that is like! Having said that, I would vastly prefer an auto-injector compared to a syringe + vial. I'm not sure if I would have the proper composure/state of mine, let alone the visual acuity (eyelids swell up real bad during anaphylactic shock) needed to operate a syringe and vial during an episode of anaphylactic shock. In more controlled situations like at a school nurse's office, where the patient isn't the administering the epinephrine to themselves, I can see the syringe and vial solution to be appropriate.
  - Johnny555 10y ago
    I don't think you've ever seen a child in Anaphylactic Shock if you think all you need to do is train the child to use a vial and needle. Even training school personnel is not a great idea - While an ER nurse or paramedic can handle it because they give injections every day, a teacher or even a school nurse may go for years without ever needing to do an epinephrine injection and the stress and inexperience may make them unable to perform under pressure of having a child dying in front of them. An IM injection is easy to do when you're calm, but just filling the syringe can be difficult when you're under intense pressure.
invaliddata 10y ago
The adrenaclick generic is much cheaper than the epipen, with or without insurance. Although technically different epinephrine auto injectors cannot be substituted (you can only be prescribed the one written by your doctor, or its generic equivalent), practically speaking the only difference between the epipen and the adrenaclick design is the instructions for use. I would hope there isn't a case of doctors being unaware of the alternatives.
- JshWright 10y ago
  I don't understand why a prepackaged vial/syringe kit isn't readily available for epinephrine. It works just fine for glucagon... http://www.childrenwithdiabetes.com/d_0n_022.htm http://www.childrenwithdiabetes.com/d_0n_022.htm We're literally talking about $1 worth of epinephrine, a $0.50 syringe, and a couple cents worth of injection molded plastic case...
  - deleted 10y ago
    [deleted]
  - retSava 10y ago
    Probably because that is not what matters. With the epipen, I can just jam it into my daughters thigh, straight through thick winter clothing and all. I don't need to ensure she gets the dosage right, nor that the syringe doesn't break.
    - JshWright 10y ago
      My point is that with a very slight increase in the complexity of the process, you could have a _dramatic_ reduction in cost. New York State is actually in the process of transitioning EMTs from EpiPens to vial/syringe kits.
      - retSava 10y ago
        EMTs are not the target customer of epipens. They work with life-threatening situations day after day. To a kindergarten teacher, if a child if having an anaphylactic chock, this is very far from a "very slight increase in complexity". Just to ground the situation, the kindergarten teachers at my daughters place are already freaked out from the thought of having to administer an epipen. I can't even start to imagine how they would handle a syringe and a bottle.
throwaway_xx9 10y ago
Just something to investigate ... I heard when working with youth trainers that in an emergency when an Epipen is not available, caffeine (like coffee) can help, and even a glass of water is better than nothing. I hope somebody who has investigated this can add more definitive info.
glusterfuck 10y ago
These are $125 for two pens or thereabouts in the UK, same device. Presumably import is regulated? https://onlinedoctor.lloydspharmacy.com/uk/allergy/epipen https://onlinedoctor.lloydspharmacy.com/uk/allergy/epipen
- tankenmate 10y ago
  Actually the NHS pays £26.45 per pen.[0] And yes it is regulated; it is considered both a drug and a medical device. [0] https://www.evidence.nhs.uk/formulary/bnf/current/3-respiratory-system/34-antihistamines-hyposensitisation-and-allergic-emergencies/343-allergic-emergencies/anaphylaxis/adrenalineepinephrine/intramuscular-injection-for-self-administration/epipen https://www.evidence.nhs.uk/formulary/bnf/current/3-respirat...
Ironchefpython 10y ago
> selling service contracts, [...] The price is still $0 and there are still no regulations on it. I assume at this point that you're being paid to shill some political viewpoint on the internet, because you just explained that the price of software isn't actually zero, because it's unusable (to the customers that buy a service contract) without a service contract, and creating a company that employs the developers that wrote the software to support that software has a high barrier to entry. (because those developers are already employed) To pick at company at random, HortonWorks. I pick on them because I recently saw an invoice. $20,000 for 16 hours of training. So by your argument, there must be some kind of regulation there, right?
- WalterBright 10y ago
  You're making quite a vast assumption that service contracts mean the software is unusable without them. Red Hat Linux is just one counterexample. A further vast assumption is that your arguments are so compelling that anyone not convinced must be a paid shill. There are many software consultants who charge over $10,000/day for doing training. Many companies find them worthwhile when amortized over a roomful of engineers. Those consultants aren't suckering anyone in by giving them free software, in fact, they don't provide any software whatsoever.
  - Ironchefpython 10y ago
    >> it's unusable (to the customers that buy a service contract) without a service contract > You're making quite a vast assumption that service contracts mean the software is unusable without them. Red Hat Linux is just one counterexample. No. I'm not. I'm basing that on the tautology that consumers of "free" software who purchase expensive service contracts spend their money purchasing expensive service contracts. Software is free in the same way that air conditioning at the mall is free, the hugs handed out by the "free hugs" guy are free, the way that the privilege of watching advertisements on TV are free. Somebody is spending time and money making this software, because they think they are going to get more out of it than they put into it (either tangibly or intangibly (except for that TempleOS guy, who does it for the voices in his head)) And this still doesn't change anything about the EpiPen. There's a consumer surplus, and the price is increased to maximize capture of consumer surplus regardless of the cost in human lives. I don't care how free software is, the price on EpiPens is going up to maximize profit. To frame this as a simple dichotomy, would you rather live in a world where people die to maximize profit, or a world where regulation is applied to reduce human suffering and death?
kuon 10y ago
Is this only in the US? I'm in Switzerland, and I bought some for my kid, I paid around 80$ per piece. http://compendium.ch/mpro/mnr/22294/html/fr http://compendium.ch/mpro/mnr/22294/html/fr You have the price at the far bottom of the page, around 76CHF. I'm a bit concerned if the price is going to be x10.
- Thlom 10y ago
  I'm not familiar with the swiss health care system, but in Norway the government foots most of the bill for prescription drugs. The government is negotiating price with the manufacturer and as a big buyer they can get a fair price.
  - mrweasel 10y ago
    I have an EpiPen, just in case, because I keep bees. It is a prescription drug, but government co-pay doesn't kick in because the price is to low. I paid USD120, around DKK800, for one EpiPen. My guess is that the US prices are higher, because insurance will pick up the bill for most people, allowing the manufacturer rise the prices with little consequence... for most people. Generally speaking Americans tend to pay a high cost for their lack of a national healthcare system, with very little benefit.
- deleted 10y ago
  [deleted]
ascorbic 10y ago
Meanwhile, in single-payer Britain the NHS pays £26 ($35). https://www.evidence.nhs.uk/formulary/bnfc/current/3-respiratory-system/34-antihistamines-immunotherapy-and-allergic-emergencies/343-allergic-emergencies/anaphylaxis/adrenalineepinephrine/intramuscular-injection-for-self-administration https://www.evidence.nhs.uk/formulary/bnfc/current/3-respira...
- lorenzhs 10y ago
  "Unfortunately this site is only available from Great Britain." - but the Google Cache works: https://webcache.googleusercontent.com/search?q=cache%3Ahttps%3A%2F%2Fwww.evidence.nhs.uk%2Fformulary%2Fbnfc%2Fcurrent%2F3-respiratory-system%2F34-antihistamines-immunotherapy-and-allergic-emergencies%2F343-allergic-emergencies%2Fanaphylaxis%2Fadrenalineepinephrine%2Fintramuscular-injection-for-self-administration https://webcache.googleusercontent.com/search?q=cache%3Ahttp...
- mattlondon 10y ago
  Even at retail (i.e. just walk into pharmacy with your prescription and buy it like you'd buy a coffee) they are £50 per pen/£90 for two [1] ($66/$118 at today's USD-GBP rate) The weird healthcare system in the US is one of the main reasons I've resisted calls to relocate there for work. Stories like this are just really off putting. 1 - https://onlinedoctor.lloydspharmacy.com/uk/allergy/epipen https://onlinedoctor.lloydspharmacy.com/uk/allergy/epipen
- nerdponx 10y ago
  B-b-but socialism!
- norea-armozel 10y ago
  You know what's weird about this situation is that often I've been told by people here in the US that the price NHS and other single payer systems pay is only possible because we here in the US supposedly pay for it at the free market price. I don't believe that myself since it wouldn't make much sense to say that the prices would plummet to such a degree as to be unprofitable. But I do wonder how much of the price would be affected if every country in the world were under single payer systems. Would it be even marginally higher? Would it be possibly lower for all? I'm not sure. But I would love to see someone analyze this to see if this is statement I keep hearing is 100% bunk.
samgranieri 10y ago
Oy. As someone who carries two of those damn things (grumble grumble Peanut allergy grumble grumble) and is a very conservative eater, this is not good. Luckily, I haven't had to use one of them in like 8 months.
grandalf 10y ago
A friend of mine has a child with an allergy and was visiting Turkey. A family member of his (in Turkey) is a physician, and said that in Turkey nobody uses epi pens and allergies are generally never the cause of visits to the ER. Is this true? What's going on?
grandalf 10y ago
Someone might reasonably wonder why a federal task force is required to investigate "price gouging" for an item that contains under $10 of materials and is not mechanically complex. Why wouldn't an entrepreneur simply introduce a competing epi-pen design and bring it to market for $300 (for example) and undercut the price being charged by Mylan? We're told to hate the Martin Shkrelis of the world, and to resend the Mylans, but the truth is that our system prevents price competition because it is designed to protect established firms. This is why many established firms and "industry leaders" strongly supported the affordable care act.
- Lambdanaut 10y ago
  But to be clear, it was the established firms that designed the system to protect established firms.
- ryguytilidie 10y ago
  For anyone as confused as I was, I'm presuming that, Michael Skakels=Martin Shkreli?
  - jo6gwb 10y ago
    My understanding as well, though it took a moment.
    - grandalf 10y ago
      Oops, that is among the more amusing typos I've committed :)
- clavalle 10y ago
  The government has created a moat for the current pen through regulation, particularly the extensive testing needed to bring it to market as a medical device whom people's lives depend on it delivering the right dosage with a low failure rate. This creates something of a small granted monopoly. It makes sense for the government to step in when something goes wrong. There are lots of theoretical arguments for a freer market that may drain that moat and allow competitors to quickly react to gouging but the reality is that consumers don't have a great way to test things like epipens and a market trial and error approach seems a little barbaric.
grandalf 10y ago
link to patent: https://www.google.com/patents/US20050273054 https://www.google.com/patents/US20050273054
BryanBigs 10y ago
Since Sanofi previously had an equivalent product on the market for at least 3 years (called Auvi-Q), I'm really curious - why were people paying up for an Epi-pen? Was it the brand name? Do schools mandate it's an Epi-pen? I know Sanofi pulled the product in October of last year, but it seems like Mylan has been raising prices during that time.
- nix0n 10y ago
  They seem to have some manufacturing trouble, leading to a recall[0] and pulling the product from the market. They mention Epi-Pen and Adrenaclick[1] as alternatives. [0]https://www.auvi-q.com/recall-faqs https://www.auvi-q.com/recall-faqs [1]http://www.goodrx.com/adrenaclick http://www.goodrx.com/adrenaclick

224 points by helloworld 10y ago

helloworld 10y ago

Why haven't competitors entered the market with cheaper products?

FLUX-YOU 10y ago
Patent on the injection system I believe
blackguardx 10y ago
It isn't a free market. There are significant barriers to entry for medical products.
pg_is_a_butt 10y ago
because you're all cowards, and the justice department takes money from the companies who are leveraging a medical survival need to generate profits for a private company who built themselves on grants and research paid with public money.
serge2k 10y ago
> Last year, the drug maker Sanofi recalled a competing product, Auvi-Q, because it may not have been delivering the correct amount of epinephrine, leaving the EpiPen as the primary emergency treatment for severe allergic reactions.
- JunkDNA 10y ago
  To all the folks in this thread suggesting 3D printing and all sorts of other ideas, keep in mind that Sanofi is not some fly-by-night or scrappy startup. They are a major pharmaceutical company with decades of experience manufacturing pharmaceuticals and the quality control that is required and even they couldn't get it right. They actually had a very innovative product. It was much smaller than the EpiPen and used voice prompts to tell you how to administer the drug (people in the heat of the moment sometimes don't remember to leave the EpiPen in long enough for a proper dose to be fully administered). I'm frankly mystified how they botched things so badly that they had to pull the product.
  - snowwrestler 10y ago
    I have to wonder how well expertise in pharmaceutical manufacturing really translates into expertise in manufacturing an auto-injector. The hard part of the EpiPen is not the drug, it's the mechanics.
Animats 10y ago
They did. Windgap[1] took venture capital, took state funding from Massachusetts back in 2012, and didn't ship the product. Cool web site, though. Sanofi tried, but their product misfired at least 26 times and was recalled.[2] Teva tried, and their product was rejected by the FDA because of problems; they're going to try again with a new model in 2017.[3] [1] http://www.windgapmedical.com/ http://www.windgapmedical.com/ [2] https://www.auvi-q.com/ https://www.auvi-q.com/ [3] http://www.fiercepharma.com/sales-and-marketing/fda-swats-down-teva-s-epipen-copy-putting-mylan-cruise-control http://www.fiercepharma.com/sales-and-marketing/fda-swats-do...
- leereeves 10y ago
  Three companies tried and failed? It sounds like it's harder than we might think to make this work. Given that, and the low volumes, it might not be that profitable even at $600 per sale.
  - ViViDboarder 10y ago
    But that R&D was spent years ago.
    - leereeves 10y ago
      I meant for a new entrant.
  - Animats 10y ago
    The companies that tried to enter the business were drug companies, not device companies. No expertise in volume manufacturing of medical-grade injection-molded plastic devices. There are companies which can do that.[1] There are automatic inspection technologies which can detect even minor flaws.[2] But the typical injection molding vendor isn't that good. Consider the typical failure rate of ball-point pens. That's consumer-grade injection molding. [1] http://www.advancedmt.com/wp-content/uploads/2012/10/amt_medicalsyringe_CS.pdf http://www.advancedmt.com/wp-content/uploads/2012/10/amt_med... [2] http://www.vision-systems.com/articles/print/volume-9/issue-8/features/industrial-automation/automated-inspection-station-rejects-defects.html http://www.vision-systems.com/articles/print/volume-9/issue-...
refurb 10y ago
They have, the products weren't up to snuff and were recalled.
ccleve 10y ago
There are really two villains here, Mylan, of course, but more importantly, the FDA. FDA regulations make the cost of bringing a new medical device to the market absurd. There are no competitors because the time and effort to bring a competing device is so ridiculously high that it doesn't pay to do so. I have a child with a peanut allergy. I am worried every damn day of my life. I see articles about people who die every year because they didn't have an Epipen handy. The numbers of people who die will increase. I want to see FDA bureaucrats hauled to those funerals so they can see what they've done.
- RockyMcNuts 10y ago
  hmmh... what's the reg, specifically? what I see is an unholy alliance between the regulators and industry to extract max profits. if you don't have an approving authority for e.g. Epipens, it seems to be that you get something like the supplements industry which is mostly marketing and exploiting the ignorant. you need some IP protection for the crazy amount of incredibly skilled R&D and massive testing that goes into an Epipen but this is ridiculous. drug and medical device companies merge for maximum market power vs. insurers, who try to merge for maximum market power against drug companies and doctors/hospitals. eventually you'll have just one insurer and one drug company and one hospital company and you can nationalize the whole thing. just kidding, but I see Obamacare failing if it can't evolve, prices continuing to go up, and eventually everyone demanding a single-payer solution.
  - Spooky23 10y ago
    Obamacare is driving regional healthcare provider consolidation as well as insurer consolidation. As drug innovation has slowed, single payer US healthcare will be the solution to these problems. Nationalize some/all of the provider networks and drugs like this become built to spec government bids where buying power drives cost down.
- dfsegoat 10y ago
  So, The FDA, because they require drug and device makers to demonstrate efficacy and safety by going through a rigorous clinical trial process, are evil? Really? I also find your comment pretty uninformed considering that the FDA just paved the way for generic drug makers to basically "knock-off" super expensive biologic drugs like Humira and Enbrel which were previously covered by similar patents. The FDA has it's problems - but to say that it is an agency staffed by people who don't care ("bureaucrats") who typically have both Ph.D and M.D.s and have dedicated their careers to ensure patients have safe and effective medicine is unfair. edit: grammar.
jevinskie 10y ago
I'm confused about this myself. I used to receive EpiPen brand auto-injectors. At some point, I started receiving Lineage Therapeutics auto-injectors (supposedly an Adrenaclick generic) instead. According to [0] they are _not_ equivalent to EpiPens according to the FDA. I'm not sure if my primary care physician or my old pharmacist (CVS chain) are at fault for not informing me of the differences. My generic prescription costs me, with insurance, $15 for two 0.3 mg autoinjectors. Insurance has covered four twin auto-injector packs (8 individual auto-injectors total) without any hassle. Either way, I have trained and informed myself on the proper use of the generic Adrenaclick auto-injector. From what I gather, the main differences are that there are two safety covers on both sides of the injector (instead of a cover on just the non-needle side) and the method of determining whether a dose was supposedly administered correctly (mainly, the EpiPen's needle cover is extended vs just observing an extended needle on the Adrenaclick). I am left to presume that their therapeutic effectiveness is the same, even though the FDA may not explicitly declare it as so. I will consult my physician and current pharmacist (local, non-chain pharmacy with excellent focus on patient care) to determine if I have any misunderstandings. I have also trained the people most likely to administer epinephrine to myself (family, friends, coworkers) the particular procedures of Adrenaclick administration, so I am not too worried about procedural differences between EpiPens and my generic auto-injector. Still, I am left wondering what the therapeutic difference between an EpiPen and a generic Adrenaclick alternative really is. I do understand that different administration procedures are a problem for training, but I would expect the actual therapeutic effects of both auto-injectors to be similar --- if used administered according to directions. [0]: http://www.pharmacytimes.com/p2p/p2pepinephrine-0910 http://www.pharmacytimes.com/p2p/p2pepinephrine-0910
- stan_rogers 10y ago
  They're not equivalent (that is, it can't be freely substituted by a dispenser) only because the devices are mechanically different. Knowing how to use an EpiPen doesn't mean knowing how to use an Adrenaclick, even if they are aministering the same drug in the same dose using more-or-less the same kind of mechanism. It's that "more-or-less" that's the key; since they differ in the way they're used and administration is quite time-sensitive, you can't assume that a person trained to use an EpiPen will be able to use an Adrenaclick properly when the time comes (or vice versa).
ec109685 10y ago
The epi pen wasn't extremely expensive until recently, so competitors had to take a different and riskier angle to make it in the market. Perhaps now a carbon copy will do well.

deleted 10y ago

[deleted]

serge2k 10y ago

Well you know, they need to recoup the R&D costs to develop the drug. > Mylan, the pharmaceutical company, acquired the decades-old product in 2007, when pharmacies paid less than $100 for a two-pen set Oh. This is why US health care is broken people.

kasey_junk 10y ago
This is one reason. Another reason is that a huge chunk of the population will simply not see these costs. For instance, I choose to be on a high deductible plan at my work (they offer both a high deductible plan and a traditional PPO). My wife has the choice of a reasonably priced HMO and a extremely expensive PPO. On my high deductible plan if I need a refill for an epipen I pay the full boat unless I'm past my deductible (or really my HSA does) on my wifes HMO plan we pay $25 every time we need one. We both have prescriptions, what is the rational decision for my family to make if we need a new epipen? That cost differences is not "free money", it comes out of the pocket of my wife's employer and peers rather than my employer and peers. There is a dramatic agency problem in the US health system as well.
- maxerickson 10y ago
  Apparently they'll cover your copay. https://www.epipen.com/en/copay-offer https://www.epipen.com/en/copay-offer (I didn't read it closely, but the eligibility criteria seem to be 'private insurance')
  - kasey_junk 10y ago
    I don't have a copay on epipens, but I do have a deductible. This actually can help me but the max is $100 off of full price (a few years ago I got $75 off with a similar card).
    - maxerickson 10y ago
      Oh, I didn't think you would be terribly concerned about the savings, I thought the company helping patients use their insurance was a nice addendum to your comment about the agency problem. Edit: The way I read it, if you give the card to the pharmacy, the company will pay the $25 on your wife's plan.

hoodoof 10y ago

Mylan refers the press to their local politicians "go talk to them about it, we pay our lobbying fees to get whoever we want elected specifically so we can charge any price we want, you can't do a damn thing - it's a free country".

deleted 10y ago
[deleted]

eliben 10y ago

If the product is decades-old, why haven't generic variants appeared? Something seems to be missing from this article.

sriram_sun 10y ago
There are generics. What is patented is the delivery mechanism. I've had to administer it twice. You take the cap off and just push it into the thigh. The top part moves back and the needle pushes through.
- eliben 10y ago
  Thanks, so this is the missing information. The article misleadingly says the medication is decades-old, where actually the pen itself is patented.
  - toomuchtodo 10y ago
    The patent is expired: https://www.google.com/patents/US4031893 https://www.google.com/patents/US4031893 Courtesy ceejayoz below: https://news.ycombinator.com/item?id=12340464 https://news.ycombinator.com/item?id=12340464
    - shanacarp 10y ago
      so why aren't there more case manufactures
      - Sanddancer 10y ago
        Because there's no equivalent of the bioequivalence study that generic drugs go through. Even if it's an exact copy, making a generic medical device means you have to go through the same entire approval process that the original went through.
      - tw04 10y ago
        For the same reason there were no competitors to daraprim before Martin Shkreli decided to be a complete ja. When the price is low enough that there's little profit to be had, nobody bothers competing because it's not worth the time, money, and effort to get FDA approval. When the price gets jacked up like that, you will find generics pop up quickly. The problem is the window between the price hike and when generics pop up can sometimes be years due to needing to get FDA approval. In this case there was a competitor, but they recently had their product pulled from the market in an FDA recall. So Mylan decided: why not raise the price 600% (and rising) when it's a drug people HAVE to have. Capitalism in action baby. Let's deregulate EVERYTHING!

Mandatum 10y ago

They don't produce EpiPen's as a generic in India because the Indian medical community does not recommend self-administration of epinephrine. If you're that much in need though, you can buy pre-filled epinephrine syringes for intramuscular injection - just keep in mind the ease-of-use of an EpiPen won't be available. You have to take the time to take off the cap, insert and inject the medicine.

shanacarp 10y ago
what happens if someone goes into anaphylaxis?
- Mandatum 10y ago
  I assume they intramuscularly inject epinephrine just as you would with an EpiPen. I doubt it'd be hard for patients to get hold of an epinephrine kit. You'll also find developing countries have far less allergic population. It's said this is partly due to urban environments having more vitamin D deficiency as well as people being more exposed to more pathogens/etc during childhood outside of developed countries.

tomohawk 10y ago

The US is subsidizing the rest of the world. When Canada decrees that the price of something will by X, then guess who pays?

otterley 10y ago
For example, an EpiPen costs $79 US ($99 AUD) in Australia.
- ceejayoz 10y ago
  That's about what it cost in the US until recently. It's a decades-old generic med, the patent on the delivery device is long expired (https://www.google.com/patents/US4031893 https://www.google.com/patents/US4031893), and the original research was even done by the US military.
  - jonahx 10y ago
    so how is this insurance company getting away with what they're doing? you'd think someone else would produce it, sell it for <$100, and people would just buy them out of pocket. what stops that?
    - serge2k 10y ago
      Other companies don't sell them. They bailed for various reasons, and the expense of getting in just isn't worth it. If you develop an EpiPen and it costs you a bunch of money then in theory you can make it up by selling more volume. Except your competitor can just cut the price because they are already selling for an absurd amount of money, so how do you win now? Maybe we should have a non-profit that does generic versions, and we can subsidize it by preferring them to companies like this (e.g. all medicare provided drugs now go through this company which sells generics). Unless the companies are willing to match prices.
    - ceejayoz 10y ago
      > so how is this insurance company getting away with what they're doing? It's not the insurance company, it's the drug company. The insurance companies are probably livid about the extra costs they're having to cover. The answer to "how" is a variety of different techniques, including changing the formulation slightly (http://www.nytimes.com/2014/09/16/business/new-york-files-antitrust-suit-against-maker-of-alzheimers-drug.html http://www.nytimes.com/2014/09/16/business/new-york-files-an...) and outright bribery of competitors (https://www.washingtonpost.com/opinions/pay-to-delay-pharmaceutical-deals-smack-of-illegal-collusion/2013/03/24/f787f0da-9338-11e2-8ea1-956c94b6b5b9_story.html https://www.washingtonpost.com/opinions/pay-to-delay-pharmac...).

gmisra 10y ago

One of the early on-line responses was "maybe we can figure out how to 3D print these cases". It turns out that an Epi-pen is just a plastic safety housing around a normal syringe. Some discussions: https://www.reddit.com/r/news/comments/4y5481/cost_of_epipen_continues_to_rise_putting_burden/d6lao38 https://www.reddit.com/r/news/comments/4y5481/cost_of_epipen... https://www.reddit.com/r/3Dprinting/comments/4y7f26/epipen_fork_of_the_enable_project/d6lmoaf https://www.reddit.com/r/3Dprinting/comments/4y7f26/epipen_f...

Cyph0n 10y ago
That second discussion got heated quite fast. I agree with the downvoters though. 3D printing a medical device is not something to take lightly. Edit: Here's why I agree. You download this design from the internet, and 3D print the parts. You then assemble it. Awesome! Some time later, you get an allergic reaction. You use the pen, but it fails to work correctly. Who's responsible? The designer? You (if you're alive)? The printer manufacturer? Your friend who emailed you the design? etc. There's a reason why even getting such a simple design considered for FDA approval and certified for use on live humans is such a long and complex process. It's easy to make something that works some of the time, but it's extremely hard to make it work essentially every time, especially in life-or-death scenarios. Of course, the price hike is terrible and the company behind it deserves punishment, but that doesn't make it OK to endanger the lives of people.
- toomuchtodo 10y ago
  Scarcity demands innovation. I don't think its being taken lightly; more like, "a private company is gouging medical users and the government won't step in". Not left with many options when your life depends on it. EDIT: Alternatively, a "better" temporary solution would be to arrange for the import of these from Canada, where the price is fixed by the government.
  - bobdole1234 10y ago
    Not so much fixed as "Canada doesn't insist that everyone make separate deals so everyone can get fucked harder". It turns out when you have millions of people dealing together as a block, they have much more bargaining power.

sevenless 10y ago

How many people will this price hike kill? I'm sure that's estimable. What would be morally justified, to stop it?

rdtsc 10y ago
Nah because it would upset the free market. I mentioned in another comment when someone from Europe or Canada asked something to the effect of "how come everything has to be free market in US even healthcare and such". And I think the answer is we treat free market as a religion. We don't evaluate what is better, healthier, more rational answer for a problem. Like say, "How do we keep people from dying from anaphylaxis?" We don't answer that. We always answer first, what would free market want? Will it want us to do this? If not, we don't proceed. We treat it as if it is deity of sorts and if we disobey we'll be punished. Someone replied and said this idea isn't so outrageous because a similar concept has been defined already in politics: American Civil Religion (https://en.wikipedia.org/wiki/American_civil_religion https://en.wikipedia.org/wiki/American_civil_religion) I am just proposing there is a similar religion in respect to free market. It is often sold in propaganda terms of course -- we are not communists here, we just want efficiency, we want progress, don't worry stuff will trickle down eventually and so on. So we make it palatable but the main incentive is worshiping the deity. It sounds crazy but evaluating a lot of things we do as a society through that perspective can be interesting.
- schmidty 10y ago
  How is government protecting a monopoly free market exactly?
  - MarkPNeyer 10y ago
    EXACTLY A free market would mean anyone who wanted to to create one of these.
  - rdtsc 10y ago
    Why is it protecting a monopoly? Why doesn't it say "this EpiPen can't cost more than $30"?

deleted 10y ago

[deleted]

shanacarp 10y ago

This is one of those devices that also should be low cost because businesses, locations, ect should have them as well as individuals (many people can have first time deadly allergic reactions, including as adults) That the price for the case is expensive just rose as random is serious business. There really is no need for it to be so expensive

robryk 10y ago
What would be the layman-evaluatable criteria for using it on a person with no history of allergy?
slowmovintarget 10y ago
I have no evidence, but this headline coupled with the insulin price hike... it really feels like this is an attempt to manufacture a crisis. I fill a prescription for epi-pens once a year (nut allergies), but insurance bears the brunt of the cost.
- gwright 10y ago
  Insurance simply distributes the high cost to many people via higher premiums. Without competition to reduce the cost or regulations that set the price by law, the high cost remains.
  - ancap 10y ago
    >or regulations that set the price by law, the high cost remains It is important to note that even such a law does not magically remove the high cost. Certain products have a high price for a reason and setting the price by fiat is guaranteed to cause shortages. That's when people really start dying. See Venezuela for a prime current example.
    - gwright 10y ago
      This is a very important point! If the fiat price is below the market price, then you are correct, shortages (or simply no product at all) are the result. If it is above the market price then the surplus is captured by the seller rather than retained by the buyer.

gkanai 10y ago

This is a simple example of how health care systems should be nationalized. Or that the profit motive in health care is corrosive to health.

ucaetano 10y ago
No it doesn't. Switzerland has one of the best healthcare systems in the world, which is completely private (although there are some public hospitals), but heavily regulated.
- leereeves 10y ago
  Heavily regulated to avoid the corrosive effect of the profit motive? You two might actually agree.
  - ucaetano 10y ago
    On that yes, in some industries a race to the bottom or winner-takes-it-all is actually bad for society, healthcare is one example. My issue is not with the "profit" part, but the "health care systems should be nationalized" part.
- robryk 10y ago
  Alas, there are significant differences between the Swiss and US one. Most importantly, law in Switzerland specifies exact coverage criteria for basic health insurance and prohibits excluding pre-existing conditions from it. I'm not sure how financing of hospitals works exactly (I was under the impression that they are at least partially publicly owned). Minor things: there are phone-a-doctor public services that are free of charge for residents in some areas. Edit: also, every company that provides basic insurance can vary the price based on a limited set of factors and must accept any person.
  - maxerickson 10y ago
    The ACA standardized basic health insurance and prohibited excluding pre-existing conditions.

xnor 10y ago

If people don't want to buy two epipen there's always that neat trick for multiple doses in precarious locations far from hospitals. It is a well known hack taught in wilderness medicine training. https://www.youtube.com/watch?v=luultUD0eK0 https://www.youtube.com/watch?v=luultUD0eK0

gradstudent 10y ago
If you have something concrete to say then say it. You're only lowering the quality of the conversation by making vague assertions in the style of "one weird trick" followed by mystery links to random places on the web.
- jevinskie 10y ago
  This "one weird trick" may save your life if you experience anaphylactic shock and do not have multiple auto-injectors available, for whatever reason (cost, some have expired, remote location, etc). I discovered this technique a couple of years ago and was interested in it. I tried replicating the use with some expired autoinjectors. As far as delivering subsequent doses, I was able to reliably deliver 2+ more doses (into oranges) from my expired injectors. I feel better prepared for an emergency now. I have never needed to use my autoinjector. I had one incident where I was very close to shooting up my thigh but the symptoms were just "mild" enough that I did not. I met another person with severe food allergies at THOTCON this year who described to me in detail two separate incidences where he felt it was necessary to administer two doses. I hadn't really given much thought to multiple doses before hearing his stories (one of which included a medically induced coma). Now I make sure to have at least two doses on hand. My doctor certainly didn't express to me the potentially dire necessity of multiple doses! Of course, this bushcraft advice doesn't hamper my cautiousness about having autoinjectors around everywhere I may need them. I have a pair at my home, my office, my parents home, and my backpack (always with me when I travel). Eight autoinjectors, that need scheduled replacement, is a luxury I can afford. Others may not be so lucky and may be helped by these bushcraft techniques. I do need to research the issue more though because my insurance currently covers eight autoinjectors (not EpiPen brand, but a "generic"? Lineage Therapeutics brand [0]) at the rate of $15 per two 0.3 mg injectors. I'm not sure if I'm lucky, have great insurance, or what. [0]: http://www.epinephrineautoinject.com http://www.epinephrineautoinject.com

ohitsdom 10y ago

The petition to Congress mentioned in the article: http://www.petition2congress.com/20720/stop-epipen-price-gouging/ http://www.petition2congress.com/20720/stop-epipen-price-gou...

nilved 10y ago

This seems less damming to me considering the medicine naturally occurs inside your body. What reason is there that nobody else can make a competing product for cheaper?

infinite8s 10y ago
Regulatory hurdles to get a new device approved.
- nilved 10y ago
  Maybe regulation is not so good after all
  - rtkwe 10y ago
    There was a competitor but it wasn't able to reliably inject the correct amount of medicine so it was recalled. [0] [0] http://www.fiercepharma.com/marketing/sanofi-s-auvi-q-recall-puts-mylan-s-rival-epipen-full-control-of-blockbuster-market http://www.fiercepharma.com/marketing/sanofi-s-auvi-q-recall...
pkaye 10y ago
The drug patent has long expired. It is an autoinjection mechanism that is patented. There have been many competitors in the market but some got recalled due to flaws.
tdy721 10y ago
I think the naturally occurring part is irrelevant. I mean it's not plutonium. Lots of interesting and unknown things are right under our noses, I don't believe that should change the value of them. The rest of your question is great, but it's a legal one, I'm no help there...

kabdib 10y ago

If your kid is allergic and needs an EpiPen (or something like it), most school districts will not allow the child to attend class unless they have one at the school. Maybe two. And of course you have to carry them. There's another two. So that's $2400. Out of pocket if you don't have insurance, or if your insurance doesn't pay. The EpiPen manufacturers are abusing their monopoly.

Mandatum 10y ago
Given the proper age, teaching kids to use syringe/vials or having a school nurse that can administer epinephrine would be a much cheaper alternative. EpiPens are purely about the delivery mechanism. Stabbing a syringe into your thigh and injecting a predetermined amount of epinephrine into your leg isn't majorly complicated. Maybe having a single pen on the kid and vials/syringes at the school would be a cheaper option.
- jevinskie 10y ago
  I've never used an auto-injector on myself before. I have used expired auto-injectors on oranges and potatoes to make sure that I have a "real feel" for how the hypodermic needle really injects. The trainer injectors certainly don't teach you what that is like! Having said that, I would vastly prefer an auto-injector compared to a syringe + vial. I'm not sure if I would have the proper composure/state of mine, let alone the visual acuity (eyelids swell up real bad during anaphylactic shock) needed to operate a syringe and vial during an episode of anaphylactic shock. In more controlled situations like at a school nurse's office, where the patient isn't the administering the epinephrine to themselves, I can see the syringe and vial solution to be appropriate.
- Johnny555 10y ago
  I don't think you've ever seen a child in Anaphylactic Shock if you think all you need to do is train the child to use a vial and needle. Even training school personnel is not a great idea - While an ER nurse or paramedic can handle it because they give injections every day, a teacher or even a school nurse may go for years without ever needing to do an epinephrine injection and the stress and inexperience may make them unable to perform under pressure of having a child dying in front of them. An IM injection is easy to do when you're calm, but just filling the syringe can be difficult when you're under intense pressure.

invaliddata 10y ago

The adrenaclick generic is much cheaper than the epipen, with or without insurance. Although technically different epinephrine auto injectors cannot be substituted (you can only be prescribed the one written by your doctor, or its generic equivalent), practically speaking the only difference between the epipen and the adrenaclick design is the instructions for use. I would hope there isn't a case of doctors being unaware of the alternatives.

JshWright 10y ago
I don't understand why a prepackaged vial/syringe kit isn't readily available for epinephrine. It works just fine for glucagon... http://www.childrenwithdiabetes.com/d_0n_022.htm http://www.childrenwithdiabetes.com/d_0n_022.htm We're literally talking about $1 worth of epinephrine, a $0.50 syringe, and a couple cents worth of injection molded plastic case...
- deleted 10y ago
  [deleted]
- retSava 10y ago
  Probably because that is not what matters. With the epipen, I can just jam it into my daughters thigh, straight through thick winter clothing and all. I don't need to ensure she gets the dosage right, nor that the syringe doesn't break.
  - JshWright 10y ago
    My point is that with a very slight increase in the complexity of the process, you could have a _dramatic_ reduction in cost. New York State is actually in the process of transitioning EMTs from EpiPens to vial/syringe kits.
    - retSava 10y ago
      EMTs are not the target customer of epipens. They work with life-threatening situations day after day. To a kindergarten teacher, if a child if having an anaphylactic chock, this is very far from a "very slight increase in complexity". Just to ground the situation, the kindergarten teachers at my daughters place are already freaked out from the thought of having to administer an epipen. I can't even start to imagine how they would handle a syringe and a bottle.

throwaway_xx9 10y ago

Just something to investigate ... I heard when working with youth trainers that in an emergency when an Epipen is not available, caffeine (like coffee) can help, and even a glass of water is better than nothing. I hope somebody who has investigated this can add more definitive info.

glusterfuck 10y ago

These are $125 for two pens or thereabouts in the UK, same device. Presumably import is regulated? https://onlinedoctor.lloydspharmacy.com/uk/allergy/epipen https://onlinedoctor.lloydspharmacy.com/uk/allergy/epipen

tankenmate 10y ago
Actually the NHS pays £26.45 per pen.[0] And yes it is regulated; it is considered both a drug and a medical device. [0] https://www.evidence.nhs.uk/formulary/bnf/current/3-respiratory-system/34-antihistamines-hyposensitisation-and-allergic-emergencies/343-allergic-emergencies/anaphylaxis/adrenalineepinephrine/intramuscular-injection-for-self-administration/epipen https://www.evidence.nhs.uk/formulary/bnf/current/3-respirat...

Ironchefpython 10y ago

> selling service contracts, [...] The price is still $0 and there are still no regulations on it. I assume at this point that you're being paid to shill some political viewpoint on the internet, because you just explained that the price of software isn't actually zero, because it's unusable (to the customers that buy a service contract) without a service contract, and creating a company that employs the developers that wrote the software to support that software has a high barrier to entry. (because those developers are already employed) To pick at company at random, HortonWorks. I pick on them because I recently saw an invoice. $20,000 for 16 hours of training. So by your argument, there must be some kind of regulation there, right?

WalterBright 10y ago
You're making quite a vast assumption that service contracts mean the software is unusable without them. Red Hat Linux is just one counterexample. A further vast assumption is that your arguments are so compelling that anyone not convinced must be a paid shill. There are many software consultants who charge over $10,000/day for doing training. Many companies find them worthwhile when amortized over a roomful of engineers. Those consultants aren't suckering anyone in by giving them free software, in fact, they don't provide any software whatsoever.
- Ironchefpython 10y ago
  >> it's unusable (to the customers that buy a service contract) without a service contract > You're making quite a vast assumption that service contracts mean the software is unusable without them. Red Hat Linux is just one counterexample. No. I'm not. I'm basing that on the tautology that consumers of "free" software who purchase expensive service contracts spend their money purchasing expensive service contracts. Software is free in the same way that air conditioning at the mall is free, the hugs handed out by the "free hugs" guy are free, the way that the privilege of watching advertisements on TV are free. Somebody is spending time and money making this software, because they think they are going to get more out of it than they put into it (either tangibly or intangibly (except for that TempleOS guy, who does it for the voices in his head)) And this still doesn't change anything about the EpiPen. There's a consumer surplus, and the price is increased to maximize capture of consumer surplus regardless of the cost in human lives. I don't care how free software is, the price on EpiPens is going up to maximize profit. To frame this as a simple dichotomy, would you rather live in a world where people die to maximize profit, or a world where regulation is applied to reduce human suffering and death?

kuon 10y ago

Is this only in the US? I'm in Switzerland, and I bought some for my kid, I paid around 80$ per piece. http://compendium.ch/mpro/mnr/22294/html/fr http://compendium.ch/mpro/mnr/22294/html/fr You have the price at the far bottom of the page, around 76CHF. I'm a bit concerned if the price is going to be x10.

Thlom 10y ago
I'm not familiar with the swiss health care system, but in Norway the government foots most of the bill for prescription drugs. The government is negotiating price with the manufacturer and as a big buyer they can get a fair price.
- mrweasel 10y ago
  I have an EpiPen, just in case, because I keep bees. It is a prescription drug, but government co-pay doesn't kick in because the price is to low. I paid USD120, around DKK800, for one EpiPen. My guess is that the US prices are higher, because insurance will pick up the bill for most people, allowing the manufacturer rise the prices with little consequence... for most people. Generally speaking Americans tend to pay a high cost for their lack of a national healthcare system, with very little benefit.
deleted 10y ago
[deleted]

ascorbic 10y ago

Meanwhile, in single-payer Britain the NHS pays £26 ($35). https://www.evidence.nhs.uk/formulary/bnfc/current/3-respiratory-system/34-antihistamines-immunotherapy-and-allergic-emergencies/343-allergic-emergencies/anaphylaxis/adrenalineepinephrine/intramuscular-injection-for-self-administration https://www.evidence.nhs.uk/formulary/bnfc/current/3-respira...

lorenzhs 10y ago
"Unfortunately this site is only available from Great Britain." - but the Google Cache works: https://webcache.googleusercontent.com/search?q=cache%3Ahttps%3A%2F%2Fwww.evidence.nhs.uk%2Fformulary%2Fbnfc%2Fcurrent%2F3-respiratory-system%2F34-antihistamines-immunotherapy-and-allergic-emergencies%2F343-allergic-emergencies%2Fanaphylaxis%2Fadrenalineepinephrine%2Fintramuscular-injection-for-self-administration https://webcache.googleusercontent.com/search?q=cache%3Ahttp...
mattlondon 10y ago
Even at retail (i.e. just walk into pharmacy with your prescription and buy it like you'd buy a coffee) they are £50 per pen/£90 for two [1] ($66/$118 at today's USD-GBP rate) The weird healthcare system in the US is one of the main reasons I've resisted calls to relocate there for work. Stories like this are just really off putting. 1 - https://onlinedoctor.lloydspharmacy.com/uk/allergy/epipen https://onlinedoctor.lloydspharmacy.com/uk/allergy/epipen
nerdponx 10y ago
B-b-but socialism!
norea-armozel 10y ago
You know what's weird about this situation is that often I've been told by people here in the US that the price NHS and other single payer systems pay is only possible because we here in the US supposedly pay for it at the free market price. I don't believe that myself since it wouldn't make much sense to say that the prices would plummet to such a degree as to be unprofitable. But I do wonder how much of the price would be affected if every country in the world were under single payer systems. Would it be even marginally higher? Would it be possibly lower for all? I'm not sure. But I would love to see someone analyze this to see if this is statement I keep hearing is 100% bunk.

samgranieri 10y ago

Oy. As someone who carries two of those damn things (grumble grumble Peanut allergy grumble grumble) and is a very conservative eater, this is not good. Luckily, I haven't had to use one of them in like 8 months.

grandalf 10y ago

A friend of mine has a child with an allergy and was visiting Turkey. A family member of his (in Turkey) is a physician, and said that in Turkey nobody uses epi pens and allergies are generally never the cause of visits to the ER. Is this true? What's going on?

grandalf 10y ago

Someone might reasonably wonder why a federal task force is required to investigate "price gouging" for an item that contains under $10 of materials and is not mechanically complex. Why wouldn't an entrepreneur simply introduce a competing epi-pen design and bring it to market for $300 (for example) and undercut the price being charged by Mylan? We're told to hate the Martin Shkrelis of the world, and to resend the Mylans, but the truth is that our system prevents price competition because it is designed to protect established firms. This is why many established firms and "industry leaders" strongly supported the affordable care act.

Lambdanaut 10y ago
But to be clear, it was the established firms that designed the system to protect established firms.
ryguytilidie 10y ago
For anyone as confused as I was, I'm presuming that, Michael Skakels=Martin Shkreli?
- jo6gwb 10y ago
  My understanding as well, though it took a moment.
  - grandalf 10y ago
    Oops, that is among the more amusing typos I've committed :)
clavalle 10y ago
The government has created a moat for the current pen through regulation, particularly the extensive testing needed to bring it to market as a medical device whom people's lives depend on it delivering the right dosage with a low failure rate. This creates something of a small granted monopoly. It makes sense for the government to step in when something goes wrong. There are lots of theoretical arguments for a freer market that may drain that moat and allow competitors to quickly react to gouging but the reality is that consumers don't have a great way to test things like epipens and a market trial and error approach seems a little barbaric.

grandalf 10y ago

link to patent: https://www.google.com/patents/US20050273054 https://www.google.com/patents/US20050273054

BryanBigs 10y ago

Since Sanofi previously had an equivalent product on the market for at least 3 years (called Auvi-Q), I'm really curious - why were people paying up for an Epi-pen? Was it the brand name? Do schools mandate it's an Epi-pen? I know Sanofi pulled the product in October of last year, but it seems like Mylan has been raising prices during that time.

nix0n 10y ago
They seem to have some manufacturing trouble, leading to a recall[0] and pulling the product from the market. They mention Epi-Pen and Adrenaclick[1] as alternatives. [0]https://www.auvi-q.com/recall-faqs https://www.auvi-q.com/recall-faqs [1]http://www.goodrx.com/adrenaclick http://www.goodrx.com/adrenaclick