Have You Ever Tried to Buy an EpiPen?
August 24, 2016 10:32 AM   Subscribe

Many adults and children with severe allergies rely on the EpiPen for emergencies. However, since 2008, the cost for a package of two has gone from $95 to $608, a price jump of more than 450%. This jump coincides with the purchase of the device by Mylan Pharmaceuticals. But why has the price of EpiPens skyrocketed? (NYT)

The New York Times explores Mylan's price hikes, which often coincide with new regulations and guidelines from the FDA. In addition, competitors have failed to bring new devices to market, and "...[t]hese setbacks, all in the last year, have once again left Mylan with a veritable run of the market."

The Atlantic notes that this issue may be unique to the US health system.
The EpiPen story may seem shocking, but it fits a pattern. Prescription drug prices are rising across the board. And for various reasons, many medicines are more expensive in the U.S. than they are elsewhere. (In France, EpiPens are sold by a different company, and they cost about $85 a pair.)
However, Mylan is noted for massive price hikes on other offerings.
Mylan has raised the prices more than 20 percent on 24 products, and more than 100 percent on seven products," Maris wrote....

....They include a stunning 542 percent increase for the drug ursodiol, which is a generic medication used to treat gallstones.

Maris also flagged a 444 percent increase in another generic drug, metoclopramide, which is commonly used to treat GERD, or gastroesophageal reflux disease as well as gastroparesis. Dicyclomine, a drug used to treat irritable bowel syndrome, had its price jacked up by 400 percent by Mylan.
Lawmakers in the Senate have begun to weigh in, drawing attention to CEO Heather Bresch's familial ties to..."her father, [Senator] Joe Manchin, a populist West Virginia Democrat whose influence is woven throughout her rise in the drug industry. " In addition, the 671% increase in Bresch's salary over the same period as the 450% price increase for EpiPens has drawn scrutiny.
posted by Existential Dread (160 comments total) 42 users marked this as a favorite
 
I`m in the wrong line of business.
posted by Keith Talent at 10:35 AM on August 24, 2016 [4 favorites]


This is just jaw-droppingly awful. The execs should be in jail. I don't understand how we can regulate prices on other things to prevent gouging, but not medication.
posted by AFABulous at 10:36 AM on August 24, 2016 [39 favorites]


I'm glad this is getting more exposure. My husband is supposed to carry an epipen, but we haven't been able to afford one for several years.
posted by PhoBWanKenobi at 10:36 AM on August 24, 2016 [20 favorites]


Because they can probobly sums up this investigation.
posted by AlexiaSky at 10:38 AM on August 24, 2016 [6 favorites]


But why has the price of EpiPens skyrocketed?

Because the ruling class feels invulnerable.
posted by Beholder at 10:38 AM on August 24, 2016 [44 favorites]


But why has the price of EpiPens skyrocketed?

...

the 671% increase in Bresch's salary over the same period as the 450% price increase

Their stock sure is taking a slide. I wonder if the shareholders will get to recoup from Bresch's salary hike! she said sarcastically
posted by rtha at 10:39 AM on August 24, 2016 [6 favorites]


When Martin Shkreli is calling you out for price-gouging on pharmaceuticals, you know you've fucked something up big.
posted by Mayor West at 10:40 AM on August 24, 2016 [23 favorites]


I don't understand how we can regulate prices on other things to prevent gouging, but not medication.

I suspect industry lobbying, among other things. Also worth noting is the decades long trend of corporate boards approving ever higher CEO salaries.
posted by ZeusHumms at 10:40 AM on August 24, 2016


the decades long trend of corporate boards approving ever higher CEO salaries

Can someone explain this from an economic standpoint? Companies are always trying to cut costs elsewhere - why such incredibly exorbitant salaries? I wouldn't even know how to spend $18 million in a year (Bresch's salary).
posted by AFABulous at 10:44 AM on August 24, 2016 [2 favorites]


Can someone explain this from an economic standpoint?

Cognitive biases are stronger than markets is pretty much it, as far as I can tell.
posted by ambrosen at 10:46 AM on August 24, 2016 [6 favorites]


A reddit post talking about this same issue had a user creating a 3D printable mold to provide a lower cost option. Apparently the drug itself isn't too expensive, just the application method of the epi-pen itself.

Here's the thread from a couple weeks ago.
posted by synthetik at 10:51 AM on August 24, 2016 [22 favorites]



the decades long trend of corporate boards approving ever higher CEO salaries

Can someone explain this from an economic standpoint? Companies are always trying to cut costs elsewhere - why such incredibly exorbitant salaries? I wouldn't even know how to spend $18 million in a year (Bresch's salary).


here
posted by lalochezia at 10:51 AM on August 24, 2016 [5 favorites]


It's right and good that there is focus on the CEO's salary, but this is A Thing at several levels of the pharmaceutical industry. I've heard stories of salespeople's perks -- not executives, much less C-level execs, just rank-and-file sales reps, and it's pretty galling. Pretty much gives lie to that whole "but they're so expensive to make" argument, which, yeah, that may be true, but maybe scaling back on the wine-and-dine shindigs and company-funded luxury vacations for those that hit their stretch goals last year could help you recoup quicker.
posted by middleclasstool at 10:52 AM on August 24, 2016 [3 favorites]


Can someone explain this from an economic standpoint?

Because companies have convinced themselves that in order to get the best CEO they need to stay competitive. Which is true if your only measure of excellence is "how much does it cost."

Also, it's worth noting that a lot of board members of large organizations are themselves vastly overpaid executives of large organizations. Here's Mylan's board. We have a former Goldman Sachs partner, the CFO of a $13.9 billion drug wholesale company, the CEO of a leading national provider of bedside diagnostics, laboratory services and hospice care, etc.

They all think they're worth that kind of money, or want to think it. Backs scratch backs.
posted by maxsparber at 10:52 AM on August 24, 2016 [19 favorites]


This guy explains it as well as anyone.

Now note very carefully that absent government force it is blatantly illegal under 15 USC, with a ten year per count felony prison term, to attempt to monopolize, restrain trade or price-fix. Therefore it is only because of the explicit, intentional and outrageous conduct of your own government that you are getting raped like this on a literal daily basis, and this issue, as I've repeatedly pointed out is not limited to EpiPens -- in fact, Mylan has raised prices on dozens of off-patent, generic medications by about the same 500% in the last few years and the only reason they get away with any of it is the above use of government force.

I'd say that NYT article goes a long way out of its way to avoid mentioning anything that might point to the real source of 'medical system dysfunction'. It's not dysfunctional, it works great at extracting money from people. Our supposedly capitalist country spends 20% of GDP on medical costs while 'socialist' countries spend 14%. How is that so if it wasn't designed to do just that.
posted by diode at 10:53 AM on August 24, 2016 [12 favorites]


> Can someone explain this from an economic standpoint? Companies are always trying to cut costs elsewhere - why such incredibly exorbitant salaries? I wouldn't even know how to spend $18 million in a year (Bresch's salary).

They cut costs elsewhere because those costs don't directly contribute to the purpose of the company. The purpose of the company is to get the money running through it as quickly and as efficiently into particular pockets. From our perspective, executive compensation is an inefficiency. From their perspective, executive compensation is the point.
posted by You Can't Tip a Buick at 10:53 AM on August 24, 2016 [49 favorites]


Chief executive pay doesn't seem to reflect performance at all (WSJ). If anything, there's a negative medium term correlation (possible academic paywall), greater pay leads to worse returns. It seems tied to status markers and perceived value.
posted by bonehead at 10:53 AM on August 24, 2016 [12 favorites]


Wow. They're the equivalent of 57 bucks here in Ieland, and we're a country I consider to be ripped off wholesale by pharma.
posted by GallonOfAlan at 10:59 AM on August 24, 2016 [1 favorite]


I wouldn't even know how to spend $18 million in a year

Buy lots of EpiPens.
posted by Greg_Ace at 10:59 AM on August 24, 2016 [36 favorites]


Because the ruling class feels invulnerable.

I mean, yes, but the device is off-patent (RTFA). Things like this shouldn't happen (at least not to this extent) in that scenario.

Manufacturing medical devices and medicines can be prohibitively expensive, which means that many generic products are only offered by one or two manufacturers. While a duopoly isn't necessarily ideal (particularly when existing firms can try to edge out new entrants into the market by lowering their own prices*), it does tend to keep prices under control, as long as there's no collusion in the market.

Basically, in this scenario, the generic manufacturers compete to try to sell their product for less money than their competitors, while still making a profit. Generally, an equilibrium is established just above the threshold of profitability. When working properly, this a great example of capitalism working to make things better for the masses.

When there's a sudden disruption in supply (which is exactly what happened here -- an existing device was recalled, and a new entrant encountered an unexpected difficulty entering the market), these same algorithms/strategies basically drove the prices through the roof.

Given that the demand for lifesaving medications is almost completely inelastic, and there are no regulations prohibiting price hikes, it's not really surprising that this happened. Where is the corporation supposed to draw the line? Should we really expect corporations to demonstrate morality or decency**?

Similarly, if there's a genuine disruption in the availability of a particular drug (ie. the only factory is destroyed in a natural disaster), pricing is arguably the simplest (albeit imperfect) way to ration the supply.

I'm generally fairly left-wing, but also believe that free-markets can have a lot of benefits, and should be allowed to flourish when they're working well. I think that the government needs to have the ability to temporarily intervene in these situations, where there is a legitimate emergency, and freeze prices until the underlying conditions have been resolved. [The difficult part would be establishing the criteria for when the government would have the ability to invoke these powers]

I also believe that companies like Mylan and Turing may indeed be exploiting the nature of this market in ways that should be illegal.

tl;dr;: "Greed" is a reductive and grossly-oversimplified way to look at this situation. While there is no shortage of corporate greed, this particular situation looks a lot like a fairly predictable (albeit rare) consequence of the economics of free-market generic drugs.

* Many big pharma companies have their "in-house" generic brands for this exact reason. I worked for one of these as an intern. I personally don't necessarily think that this is particularly evil, but rather an unavoidable consequence of having patents and a free(ish) market, which has historically been a net positive for all involved.

** I also don't think that a legacy pharma company would have done this. They're no angels, but I could see this kind of price-hike encountering a lot of pushback internally, and would also suspect that the executives would decide that the negative PR doesn't justify a quick cash-out – these high prices are going to end the moment that Sanofi and Teva have widely-available competing products on the market.

posted by schmod at 11:01 AM on August 24, 2016 [34 favorites]


Seems like the textbook case for more competition = good.
posted by blue_beetle at 11:01 AM on August 24, 2016 [3 favorites]


> Seems like the textbook case for more competition = good.

Says the guy who clearly hasn't cornered any markets lately!
posted by You Can't Tip a Buick at 11:03 AM on August 24, 2016 [12 favorites]


End-stage triangulation of healthcare.
posted by a lungful of dragon at 11:04 AM on August 24, 2016 [1 favorite]


So, it's pretty well known that the US consumer subsidizes the R&D cost for most other nations. But what's happening now is really weird in that every time I see a thing about how drug manufacturers are gouging sons of bitches, it's for things that are actually off patent and being sold by companies that do no research and probably run the entire show throw contract manufacturers.

(On preview, I think schmod and I are related.)
posted by Kid Charlemagne at 11:07 AM on August 24, 2016 [6 favorites]


Is it beating a dead horse to also note that in FY2015 Mylan reported $847million in profits and paid $67million in taxes for an effective tax rate of 7.9%? Oh, and thats with $2billion in operating cashflow (aided by >1bil in depreciation, which geez considering the profitability of off-patent products seems alarmingly high).
posted by H. Roark at 11:08 AM on August 24, 2016 [4 favorites]


I'm glad that this is getting press. The issues is not new, but it has gotten to the point of absurdity.

I am an ENT doctor and I have some patients on allergy immunotherapy (allergy shots or drops). They are required to have an EpiPen and I've had a couple of patients discontinue therapy because they can't afford an EpiPen anymore.

A few others have told me that they've ordered them online from Canadian pharmacies for $50-70. I'm not sure if I'm allowed to suggest that my patients do the same, but I do tell them that "some patients have done it" and leave it at that.
posted by Fritzle at 11:09 AM on August 24, 2016 [10 favorites]


From our perspective, executive compensation is an inefficiency. From their perspective, executive compensation is the point.

It is fairly perverse to consider. I work on a daily basis with people who are trying to start companies to solve various worldly problems (clean energy expansion to combat climate change, new medical devices, on and on) and more often than not their primary goals become at best secondary to remuneration of the investors who make their company possible.
posted by Existential Dread at 11:10 AM on August 24, 2016 [1 favorite]


Seems like the textbook case for more competition = good.

I was going to say, "this seems like the textbook case for the feds to break up an illegal de facto monopoly and dangle the principals upside down until money stops falling out of their pockets," but I celebrate our differences.
posted by Mayor West at 11:13 AM on August 24, 2016 [72 favorites]


>> From our perspective, executive compensation is an inefficiency. From their perspective, executive compensation is the point.

> It is fairly perverse to consider.


Nevertheless, it's the terrain we're operating on. pretending that it's otherwise or talking about how it should be otherwise won't fix anything.
posted by You Can't Tip a Buick at 11:13 AM on August 24, 2016 [3 favorites]


Heather Bresch is just dirty all 'round, so par for the course, with that one.
posted by Gyre,Gimble,Wabe, Esq. at 11:13 AM on August 24, 2016 [2 favorites]


> I was going to say, "this seems like the textbook case for the feds to break up an illegal de facto monopoly and dangle the principals upside down until money stops falling out of their pockets," but I celebrate our differences.

Hey is this one of those situations where nationalizing the company seems like a reasonable compromise?
posted by You Can't Tip a Buick at 11:16 AM on August 24, 2016 [1 favorite]


Heather Bresch is well known around here for having some shaky ethics.
posted by octothorpe at 11:16 AM on August 24, 2016 [1 favorite]


Greed is a perfectly apt description of a situation of a third-party, which neither paid for development or approval of the device, maximizing returns on consumers that have no choice but to buy its product. There's no return on investment here, just profit-taking on a consumer base that has to decide between buying the product and risking their own death.

From NBC: "After Mylan acquired EpiPen the company also amped up its lobbying efforts. In 2008, its reported spending on lobbying went from $270,000 to $1.2 million, according to opensecrets.org. Legislation that enhanced its bottom line followed, with the FDA changing its recommendations in 2010 that two EpiPens be sold in a package instead of one and that they be prescribed for at-risk patients, not just those with confirmed allergies. And in 2013 the government passed a law to give block grants to states that required they be stocked in public schools."

From Bloomberg: "Mylan spent about $4 million in 2012 and 2013 on lobbying for access to EpiPens generally and for legislation, including the 2013 School Access to Emergency Epinephrine Act, according to lobbying disclosure forms filed with the Office of the Clerk for the House of Representatives. Mylan also was the top corporate sponsor of a group called Food Allergy Research & Education that was the key lobbyist pushing for the bill encouraging schools to stock epinephrine auto-injectors, of which EpiPen is by far the leading product."

So this situation was to a large degree engineered by Mylan to increase demand. It's pretty clear what we're seeing is the end-game of a nearly decade long corporate strategy to maximise revenue on an acquisition. The free market in operation.
posted by bonehead at 11:18 AM on August 24, 2016 [31 favorites]


I was going to say, "this seems like the textbook case for the feds to break up an illegal de facto monopoly and dangle the principals upside down until money stops falling out of their pockets," but I celebrate our differences.

They don't even need to do that. They just need to wait for Teva to get their competing product approved, and the problem solves itself.

Once this situation happens, as long as there's a large enough market for the product (in this case, there is), the free market can almost definitely correct the situation more quickly than government intervention can.

The problem is that this keeps happening. We need proactive solutions. We already know how to react to the crisis. We need to know how to prevent the crisis.
posted by schmod at 11:20 AM on August 24, 2016 [8 favorites]


Some of this is about monopolies and the difficulties of bringing a new, competing medical device to market. Some of it's about executive compensation. But it's also about unfair advantages gained by companies who spend money lobbying the government.

From NBC News:
After Mylan acquired EpiPen the company also amped up its lobbying efforts. In 2008, its reported spending on lobbying went from $270,000 to $1.2 million, according to opensecrets.org.
The links up top detail ways that government regulation have vastly increased the market for EpiPens, including requiring that be sold in 2-packs instead of singly, offering payments to states that purchase stockpiles of EpiPens, and changing the indications to open the market to significantly more patients who don't even have any documented allergies. There are good-ish reasons for all of these things, but I bet the lobbying expenditure is how those issues made it to the top of each to-do pile to get the attention they needed to be approved.
posted by vytae at 11:22 AM on August 24, 2016 [2 favorites]


> So this situation was to a large degree engineered by Mylan to increase demand. It's pretty clear what we're seeing is the end-game of a nearly decade long corporate strategy to maximise revenue on an acquisition. The free market in operation.

I mean the strategy is a thing of beauty, you have to give them that. It's a case study in how to manufacture and then exploit an opportunity for profit.

After the revolution (there is no revolution, no revolution is possible, no revolution will ever come), what we'll do is give the deposed executive class access to all the best ships in EVE Online, so that they can devise and run their genuinely brilliant exploits in a context where the only deaths are imaginary.
posted by You Can't Tip a Buick at 11:23 AM on August 24, 2016 [7 favorites]


consumers that have no choice but to buy its product

I feel like I'm flogging a dead horse here, but Epi-Pen is off-patent. This was demonstrably not the case until very recently. Consumers had a choice until they suddenly didn't (for reasons that had nothing to do with Mylan).

This doesn't make their behavior at all ethical, but I really think we need to emphasize that this particular situation is a really weird edge-case that they could not possibly have anticipated.

The lobbying efforts are weird and disgusting, but don't appear to be related to the current crisis.

offering payments to states that purchase stockpiles of EpiPens

I was going to suggest that mandatory [state-owned] stockpiles would be an effective means to prevent this sort of thing from happening.

Maybe it's time to start selling off those stockpiles, and throw Mylan's lobbying efforts back in their faces?

----

Seriously. I know that there are a lot of right-wing bogeymen and really terrible people lurking on the fringes of this story, but please use some critical-thinking before declaring that they're the literal cause of all problems. This is a complicated issue.
posted by schmod at 11:27 AM on August 24, 2016 [3 favorites]


The problem is that this keeps happening. We need proactive solutions.

This doesn't happen as much or as often in other countries. Allow the big public insurers to negotiate on prices. Allow quotas and approved lists. Allow for more easy licensing by generics and use that as a threat to keep markets open. All of these have been used in Canada to control drug prices.
posted by bonehead at 11:27 AM on August 24, 2016 [11 favorites]


Once this situation happens, as long as there's a large enough market for the product (in this case, there is), the free market can almost definitely correct the situation more quickly than government intervention can.

I'm OK with that, with one stipulation: if it comes out that a child died because their parents weren't able to afford an artificially-expensive epi pen during the time when the free market failed to correct the situation, every C-level exec and board member of Mylan gets tried for felony murder. Deal?
posted by Mayor West at 11:28 AM on August 24, 2016 [49 favorites]


Companies are always trying to cut costs elsewhere - why such incredibly exorbitant salaries?

Because those are the point of cutting costs elsewhere.
posted by flabdablet at 11:30 AM on August 24, 2016 [10 favorites]


I can't even read this article the headline makes me so fucking livid.

Single Payer/Medicaid price negotiations/regulate this bullshit extortion industry now.
posted by latkes at 11:30 AM on August 24, 2016 [6 favorites]


When there's a sudden disruption in supply (which is exactly what happened here -- an existing device was recalled, and a new entrant encountered an unexpected difficulty entering the market), these same algorithms/strategies basically drove the prices through the roof.

Yeahbut, another way to say this is that the management of Mylan are vile, disgusting people who do not care that their actions will result in the utterly avoidable, painful, and traumatic deaths of real live human beings and the long-lasting suffering of their families and friends. This is not a normal business decision; this and related decisions are things that mark their makers to be, unavoidably and simply, bad people that decent people should not associate with.
posted by ROU_Xenophobe at 11:32 AM on August 24, 2016 [35 favorites]


My wife has a severe cat allergy and has been prescribed an Epi-Pen, but they have a short shelf life and at this price we can't afford them. Luckily there is a low risk, and she can avoid cats (for the most part), but I feel for people who depend on them.
posted by terrapin at 11:33 AM on August 24, 2016 [2 favorites]


It's a last-ditch attempt to gouge the market before Teva gets FDA approval on their generic Epipen.
According to Wikipedia "In 2000, the company agreed to pay $147 million to settle accusations by the FTC that they had raised the price of generic lorazepam by 2,600% and generic clorazepate by 3,200%.", so they've been at this for a while.

Mylan is a real class-act, also being the sole provider to US states of the drug rocuronium bromide for lethal injections.

It would be nice to fight back by actively boycotting all Mylan products whenever possible, but as their main business is in generics that is hard to do, as you often won't even see their name or get a choice.
posted by w0mbat at 11:34 AM on August 24, 2016 [16 favorites]


EpiPens in the UK seem to be around fifty quid, so in line with non-USA prices. Clearly, there are large global stocks of these devices at more reasonable prices, and I don't understand why even if there was a supply crunch in the US due to recalls and failed approvals, more couldn't be brought in from outside. Is that due to different approval regimes?

Stockpiling medicines is not a sensible idea where shelf life is short, unless you have to guard against a sudden increase in demand which will outpace production. Wikipedia tells me that EpiPens have a shelf life of 12-18 months, and I can't immediately see a situation where there's an unexpected surge in demand for a treatment aimed at a chronic, non-infectious condition. Giant swarms of bees?
posted by Devonian at 11:38 AM on August 24, 2016 [3 favorites]


The lobbying efforts are weird and disgusting, but don't appear to be related to the current crisis.

Epipen has always been the market leader. Their competitors have stumbled, buy they have always been in the driver seat. The price increases have not been sudden, in response to the just the failure of Adrenaclick and Twinject. They've been steady and obviously planned. While I don't think they had planned on specific failures, I think it would be naive in the extreme to think that a central part of these (and similar) strategies was not to profit from a market that has proven to be very hard to enter.
posted by bonehead at 11:38 AM on August 24, 2016 [1 favorite]


This was demonstrably not the case until very recently.

But now it is, and that's what's under discussion. Anyway, tell me more about the first day of high school economics class
posted by invitapriore at 11:41 AM on August 24, 2016 [5 favorites]


So, it's pretty well known that the US consumer subsidizes the R&D cost for most other nations.

Believed not known.
posted by srboisvert at 11:43 AM on August 24, 2016 [13 favorites]


So, it's pretty well known that the US consumer subsidizes the R&D cost for most other nations.

LOL

The Atlantic notes that this issue may be unique to the US health system.

I really wish for the old days of journalists who spoke foreign languages and did a minimum amount of research for stuff like this.

The EpiPen in France costs 75 euros (I rounded from the cents) and is fully reimbursed with a prescription, which when you know how national healthcare works here, means that you go to your GP, they deem your allergies mean an Epipen is worth prescribing, you take the prescription to a pharmacy, show them your national healthcare card, and pay zero euros (because the pharmacy will be reimbursed, not you).
posted by fraula at 11:46 AM on August 24, 2016 [24 favorites]


Drug companies have become very coy about cleanly reporting marketing vs. development costs. I wonder why that is?
posted by bonehead at 11:48 AM on August 24, 2016 [3 favorites]


An Epipen costs the NHS about £27 (Devonian's cost of about £50 is also correct - the NHS is a bulk-buyer and generally gets better prices than individuals). Cost to patient: between £0 and £8.40.
posted by Vortisaur at 11:54 AM on August 24, 2016 [7 favorites]


I'm generally fairly left-wing, but also believe that free-markets can have a lot of benefits

Not me. I've gone full commie on economics. If it's a sector the public depends on, financial, medical, transportation, communication, etc, nationalize it.
posted by Beholder at 11:55 AM on August 24, 2016 [36 favorites]


But now it is, and that's what's under discussion. Anyway, tell me more about the first day of high school economics class

If this is an actual problem, we should figure out the ACTUAL REASON why it's happening if we want to ACTUALLY FIX IT

I know it's very heroic to post random speculation so please do not ever stop doing that, metafilter

But understanding things is not actually the enemy
posted by Rock 'em Sock 'em at 11:56 AM on August 24, 2016 [1 favorite]


The whole for-profit medical industry is naked, immoral profiteering. If we merely hold them upside down and shake all the money out of their pockets and leave them destitute on the street, they should thank the Lord above for the merciful treatment.
posted by tobascodagama at 11:59 AM on August 24, 2016 [3 favorites]


After the revolution (there is no revolution, no revolution is possible, no revolution will ever come),

Of course there have never been any revolutions ever before in human history, so obviously there can never be any in the future. "It is easier to imagine the end of the world than the end of capitalism" (Slavoj Zizek).
posted by Coda Tronca at 12:01 PM on August 24, 2016 [1 favorite]


In a statement issued Monday, Mylan said it has savings programs for patients and is also offering free EpiPens to schools. The company said around half of U.S. schools are participating in that program.

The news orgs are really doing a totally shit job of reporting on this. Just massively shit. If Congress requires epipens in schools and Mylan is providing a lot of them free, it's probably not a huge conspiracy moneymaker that takes *millions of dollars in lobbying to buy.

Probably this was what made Mylan think they could get away with the PR issue for hiking the price, though.
posted by Rock 'em Sock 'em at 12:01 PM on August 24, 2016 [2 favorites]


...I really think we need to emphasize that this particular situation is a really weird edge-case that they could not possibly have anticipated.

Except, as I said up-thread, I keep seeing "OMG, LOOK AT TEH GOUGING! DAMN BIG PHARMA TO HECK!" memes and, especially in the last few years, it's almost never one of the big companies and more often than not it's an off patent drug. That's not how things worked 20 years ago. It used to be the innovator charged more during it's protected period to pay off the cost of the innovation and, then, the price fell. Sometimes pretty precipitously.

Now, relatively suddenly, companies that aren't "big pharma", that often would be "mom and pop small artisanal pharma" (except the companies in question don't actually do any of that sweaty manufacturing stuff on their own preferring to contract everything but counting the money out to other companies are making grotesque profits on things that are off patent - sometimes charging prices much higher than the original patent holders ever did. It's not a one off thing at all any more.
posted by Kid Charlemagne at 12:02 PM on August 24, 2016 [12 favorites]


US consumer subsidizes the R&D cost for most other nations.

Consider also that the US is one of the few places in the (developed) world where direct to consumer medical advertising is also allowed.
posted by bonehead at 12:02 PM on August 24, 2016 [8 favorites]


A reddit post talking about this same issue had a user creating a 3D printable mold to provide a lower cost option. Apparently the drug itself isn't too expensive, just the application method of the epi-pen itself.

Here's the thread from a couple weeks ago.


Awesome! I was thinking about that after watching Nightly Business Report's usual soft-pedaling on how companies make a profit, when hearing that 1) the medicine is generic, and 2) the company reportedly made $1.2 BILLION in PROFIT off of the injection devices, which 3) is "single dollars" for the medicine, plastic and metal.

But you can't simply wait and hope for your local maker collective to print the devices you need to get potentially life-saving generic medicine administered. So why don't governments take over the manufacturing of generic drugs and drug delivery devices? Besides "we don't do that, we pay people to do that." If you pay someone to make something for you, why not just hire them (or someone like them) and do it all in house?

/public servant rant against consultant services for services that could be completed in-house without the additional bureaucracy of contract management and oversight in addition to the rest of the mandatory review systems.
posted by filthy light thief at 12:04 PM on August 24, 2016 [1 favorite]


If we merely hold them upside down and shake all the money out of their pockets and leave them destitute on the street....

A fine economic model if one assumes that we already have all the drugs we need and that people who know how to run a 10,000 liter bioreactor are big into that whole mendicant thing.
posted by Kid Charlemagne at 12:05 PM on August 24, 2016 [3 favorites]


OMG this is so relevant. We had a some... enthusiastic discussions about the cost of epi-pens in some of the recent food allergy threads, and it's so hard to stay calm when my LIFE SAVING medication is more expensive than any other part of my health expenses.

I have a great job, solid insurance, and extremely severe food allergies and epi-pens are my single biggest health expense each year. my insurance coverage just can't keep up with the price increases- a few years ago I paid ~$30 out of pocket after my insurance payment; last time I picked them up it was $250! after insurance! and I need to buy them 3-4x a year due to use or expiration.
posted by larthegreat at 12:06 PM on August 24, 2016 [9 favorites]


A fine economic model if one assumes that we already have all the drugs we need and that people who know how to run a 10,000 liter bioreactor are big into that whole mendicant thing.

Shh you can build anything you need at home w/a 3D printer
posted by Rock 'em Sock 'em at 12:06 PM on August 24, 2016 [5 favorites]


Mylan will charge whatever the market will bear. The question is why other companies haven't entered the market.
posted by jpe at 12:10 PM on August 24, 2016


From the NYT article:
Of course, competition would bring the price down. But it’s very hard to bring such a device to market. In 2012, the Adrenaclick and Twinject were discontinued. In 2013, Sanofi began to sell Auvi-Q devices, which even gave audio instructions to walk people though their use. Unfortunately, they were found to give potentially improper doses, and were pulled from the shelves about a year ago.

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

Adamis hoped to offer prefilled syringes, which would still be harder to use than EpiPens. But it was told by the F.D.A. that much more data would be needed before such a product could be sold.
Essentially, you need to successfully get FDA approval for the device, and you need insurers to reimburse for it.
posted by Existential Dread at 12:12 PM on August 24, 2016 [9 favorites]


A fine economic model if one assumes that we already have all the drugs we need and that people who know how to run a 10,000 liter bioreactor are big into that whole mendicant thing.

I'm not sure the executives are the people you describe, though. And I'm not sure how cracking down on regulatory barriers to entry created monopolies on generics being abused dissuades innovation.
posted by Dysk at 12:17 PM on August 24, 2016 [9 favorites]


A fine economic model if one assumes that we already have all the drugs we need and that people who know how to run a 10,000 liter bioreactor are big into that whole mendicant thing.

Yes, because clearly venture capital is the only source of money in the whole entire world.
posted by tobascodagama at 12:19 PM on August 24, 2016 [2 favorites]


Corporations are heartless sure, but they are rational.

Turning Mylan into a smoking crater, jailing a few board members and impoverishing its investors will demonstrate that the strategy of buying a (mostly) single-vendor out of patent drug, one which has an on-going need ideally, then boiling the frog over a decade or so, is a loser. You can be smart, you can get a cushy market, you can even lobby for your own private regulations, but you can't get too greedy, as both Mylan has and Turing before them did.

If Turing Pharma wasn't enough of a lesson, then Mylan can be next. Maybe this time the lesson will stick.
posted by bonehead at 12:19 PM on August 24, 2016 [11 favorites]


Turning Mylan into a smoking crater, jailing a few board members and impoverishing its investors will demonstrate that the strategy

Or: assume a can opener.
posted by jpe at 12:24 PM on August 24, 2016 [1 favorite]


Kid Charlemagne: "But what's happening now is really weird in that every time I see a thing about how drug manufacturers are gouging sons of bitches, it's for things that are actually off patent and being sold by companies that do no research and probably run the entire show throw contract manufacturers."

That's because these cases are impossible to hand wave away with talk about development costs. Even the most ignorant can see these are clear cases of gouging and profit taking.

Kid Charlemagne: "A fine economic model if one assumes that we already have all the drugs we need and that people who know how to run a 10,000 liter bioreactor are big into that whole mendicant thing."

I'd be willing to bet that no one who has had a 671% increase in salary without a proportional increase in responsibility knows how to operate a 10Kl bioreactor.
posted by Mitheral at 12:31 PM on August 24, 2016 [21 favorites]


people who know how to run a 10,000 liter bioreactor

There are quite a lot of these people, an over-supply domestically really, if the lay-offs many of my friends and family have experienced in the past five years is typical. Nor does it typically take an obscene amount of capital to do so. This is largely why there are a billion and one contract labs in China, IMO. It's relatively routine work that most MSc and.or PhDs can do. Lord knows there are enough of them around. Getting GLP certification is a bit of a speed bump, but not too big.

Making drugs is pretty routine, but that's not at all what this is about. It's about getting a device (or packaging) the F.D.A. will approve to market. That's the expensive bit and the part I'd want to look at most closely on review. Those barriers are largely what is protecting the markets and what both Turing and now Mylan have depended upon to protect their margins.
posted by bonehead at 12:37 PM on August 24, 2016 [9 favorites]


In addition, the 671% increase in Bresch's salary over the same period as the 450% price increase for EpiPens has drawn scrutiny.

Even at the inflated price the difference between Bresch's 2007 and 2015 compensation is enough to buy 27,000 epi pens. At the $95 price it's enough to buy 167,000 epi pens.

I'm sure Bresch sleeps well on that dragon's horde.
posted by nathan_teske at 12:47 PM on August 24, 2016 [1 favorite]


Putting it another way, Bresch's pay increase is enough to pay for an injection every 20 minutes 24/7/365 and still have a several hundred doses left over. And that's at the $608 price.
posted by nathan_teske at 12:56 PM on August 24, 2016 [2 favorites]


That's because these cases are impossible to hand wave away with talk about development costs. Even the most ignorant can see these are clear cases of gouging and profit taking.

That's a take I hadn't considered (and my casual observation is an anecdote, not data) but it seems like there's enough of this kind of thing going on that it's no longer an outlier but a trend.

Heh, so I went away looking for more in this, found scads of stuff on the 1989 Generic Drug Scandal but then there was this Notre Dame Law Review paper. In 1999. Familiar names show up and things get interesting on the bottom of page 336 (p. 29 of the pdf).
posted by Kid Charlemagne at 12:59 PM on August 24, 2016 [2 favorites]


I suppose the underlying technical problem here is : In an emergency, the patient lacks the time to load a dose into a normal syringe, so the dose must be loaded already. Air bubbles should not be injected into the blood stream, so the patient cannot be trusted to load a reusable injector themselves. At the same time, the medication must be periodically replaced, so the whole injector must be replaced. Is that about it?
posted by jeffburdges at 1:02 PM on August 24, 2016 [3 favorites]


> I suppose the underlying technical problem here is : In an emergency, the patient lacks the time to load a dose into a normal syringe, so the dose must be loaded already. Air bubbles should not be injected into the blood stream, so the patient cannot be trusted to load a reusable injector themselves. At the same time, the medication must be periodically replaced, so the whole injector must be replaced. Is that about it?

I'm not comfortable bracketing off the question of what sort of object is to be manufactured from the question of actually getting it to market. On the one hand, it's sensible for government to very tightly regulate the production of this product for this use, because if it's ever mismanufactured dead people happen. And on the other hand, it's sensible for a well-positioned company that currently has an effective monopoly on the product to fiddle with those regulations to make sure that they can hold onto their monopoly for as long as they can, since people will pay basically everything they can for products that keep them from dying.

I mean we all know this. What I want to draw attention to is that the type of problem you're describing as the underlying problem ("how do I build a thing to do this thing?") is a technical problem — but the type of problem I'm describing ("how do we get approval to sell this thing? how do we get approval to sell this thing while an 800 pound gorilla is throwing its weight around to keep me from selling this thing?") is also a technical problem, and a much more difficult one. And, I'd argue, it's a better candidate for "underlying technical problem" than the one you've identified. The reason I'm bringing this up is that oftentimes people think that once they've identified the underlying technical problem, they think they can, or should be able to, magic away other concerns — even when those other concerns are where the real technical difficulty appears.
posted by You Can't Tip a Buick at 1:15 PM on August 24, 2016 [5 favorites]


Epinephrine needs to be injected into muscle, not the bloodstream. It takes some training to do this right with a standard syringe. Plus, for most needles you'ld probably need to get the person's legs bare. Get it wrong, hit a blood vessel and you can strain the heart, so the downsides are not great either.

The autoinjector solves a lot of problems.
posted by bonehead at 1:22 PM on August 24, 2016 [4 favorites]


Of course, competition would bring the price down. In 2013, Sanofi began to sell Auvi-Q devices, which even gave audio instructions to walk people though their use. Unfortunately, they were found to give potentially improper doses, and were pulled from the shelves about a year ago.

They were more expensive than Epi-pens, as I recall, which were themselves already very expensive. Doesn't that suggest that competition really doesn't keep prices down?

These articles mention that they expire after a year, but they don't mention that it's actually very hard to find ones that will last even that long. Pharmacies will often have nothing in stock but Epi-pens that expire in 7-8 months.
posted by Ralston McTodd at 1:26 PM on August 24, 2016 [2 favorites]


If this is an actual problem, we should figure out the ACTUAL REASON why it's happening if we want to ACTUALLY FIX IT

Someone did that already. They even wrote an article about it in the New York Times!
posted by invitapriore at 1:40 PM on August 24, 2016 [7 favorites]


I'm OK with that, with one stipulation: if it comes out that a child died because their parents weren't able to afford an artificially-expensive epi pen during the time when the free market failed to correct the situation, every C-level exec and board member of Mylan gets tried for felony murder. Deal?

It's a false dichotomy. The prices are already too high; people already can't afford it.

I was specifically responding to the proposal that we "hold them upside down and shake all the money out of their pockets and leave them destitute on the street."

While I doubt that this is what was literally being proposed, it wouldn't be possible to dismantle a pharma corporation overnight, and resume production at the old prices the next day. It's likely that there would be major shortages and supply-chain disruptions in the interim. The process could take years, and wouldn't even be possible if the corporation is located outside of the country.

"Dismantle the company and put the execs' heads on a pike" is not a realistic proposal. There would still be shortages, and people would still suffer. It's much easier to set up an alternative source than it is to try to coerce a demonstrably-evil corporation to provide a public service. My comment was not meant to be "Herp, derp, government inefficient; private sector good" -- it's that it's unclear what the actual process of seizing the assets of a pharma company would even look like.

My suggestion would be for some combination of price-controls, patent-revocation, selling off existing stockpiles at historic rates, and greasing the rails for another competitor to enter the market as quickly [and safely] as possible.

As I've mentioned upthread, once the conditions exist for something like this to happen, it's already too late. We need to be proactive instead of reactive.

[None of this precludes litigating Mylan out of existence, by the way. We just need to be doing more to make sure it's impossible for this to happen instead of responding vindictively after it does.]
posted by schmod at 1:43 PM on August 24, 2016 [4 favorites]


Greed certainly is toxic.
posted by theora55 at 1:53 PM on August 24, 2016 [1 favorite]


I'm OK with that, with one stipulation: if it comes out that a child died because their parents weren't able to afford an artificially-expensive epi pen during the time when the free market failed to correct the situation, every C-level exec and board member of Mylan gets tried for felony murder. Deal?
Considering that Bayer/Cutter executives knowingly offloaded HIV tainted blood products for hemophiliacs to Asian and Latin American countries and not a single person went to jail, I don't have much faith in the likelihood of felony murder charges for Epi-Pen price fixers.
posted by xyzzy at 2:02 PM on August 24, 2016 [15 favorites]


Kid C: So, it's pretty well known that the US consumer subsidizes the R&D cost for most other nations.

LOL.

The idea that the rest of the world is somehow sponging off the US public & failing to pay our way is the kind of bullshit PR meme that some pharma exec has been rubbing their hands with glee over for what, decades now? Yet it’s transparently, obviously bullshit. One look at the R+D budgets of EU-based pharma companies tells you that it’s bullshit.

US consumers are paying more than anyone else for pharma drugs because the US healthcare system is so comprehensively broken that it makes it possible for the pharma companies to price gouge in the US in ways that would be utterly illegal in other parts of the world. There is no other reason.
posted by pharm at 2:03 PM on August 24, 2016 [31 favorites]


One look at the R+D budgets of EU-based pharma companies tells you that it’s bullshit.

There are different, better refutations of the "US subsidizes the rest of the world" idea, but this one is not correct. The EU based Pharma companies still generate a disproportionate share of their revenues in the US.

Sanofi = 12 bil on 34 Bil
Roche = 22 bil on 50 bil
Novartis = 18 on 49
Lundbeck - 6.4 on 14
Astra 10 on 24
GSK 13 on 23

And that probably understates it given there are usually some non-pharma revenues in there.
posted by JPD at 2:11 PM on August 24, 2016 [2 favorites]


I'm OK with that, with one stipulation: if it comes out that a child died because their parents weren't able to afford an artificially-expensive epi pen during the time when the free market failed to correct the situation, every C-level exec and board member of Mylan gets tried for felony murder. Deal?

By this logic, it seems that every med-pharma company that is not run as a non-profit is a criminal cartel. This is a valid stance to take, but you should own it.
posted by sparklemotion at 2:11 PM on August 24, 2016 [1 favorite]


As bad as the Epipen pricing is, it could be worse. Consider the pricing of insulin.
A medical professor who has tracked the cost of insulin over the years says that a one-month supply of a popular version that cost $45 wholesale in 2001 cost $1,447 14 years later, an increase of almost 3,000%. That’s the wholesale price, not the retail price that an uninsured patient would pay.
posted by Kirth Gerson at 2:13 PM on August 24, 2016 [9 favorites]


It sounds like the real problem is that the old Epi-pen pricing wasn't high enough to entice someone in to the market, so Mylan has figured out he best way to maximize their economic returns is to crank prices sky high for the few years it takes someone else to get an injection device to market.

Its horrible and bullshit, and an argument for price controls, but the problem will be solved eventually.

There are more egregious drug pricing problems then this. Which isn't to say this isn't egregious.
posted by JPD at 2:14 PM on August 24, 2016 [2 favorites]


A medical professor who has tracked the cost of insulin over the years says that a one-month supply of a popular version that cost $45 wholesale in 2001 cost $1,447 14 years later, an increase of almost 3,000%. That’s the wholesale price, not the retail price that an uninsured patient would pay.

Evil Europeans control 70% of the market.
posted by JPD at 2:16 PM on August 24, 2016


yeah I guess when I get down on America, I take consolation in the knowledge that we've got access to a sort of universal excuse — no matter what awful thing we do, we can always point at Europe and say "we learned it from you!! from you!!"
posted by You Can't Tip a Buick at 2:21 PM on August 24, 2016


Its true!!!
posted by JPD at 2:31 PM on August 24, 2016


Evil Europeans control 70% of the market.

Insulin is quite similar, though not as dramatic, a small number of suppliers profit taking in advance of future competition. The dawn of these biosimilars is one reason prices are out of control, says Hirsch: Drug companies are trying to rake in as much money as they can before these cheaper alternatives enter the market.

One reason I think the "nuke from orbit" response is valuable in a few limited cases is to put the fear of regulation into these funds who seem to be targeting these opportunities. Let the market know that while some profit-taking is ok, as long as it doesn't get out of hand, if greed gets rapacious, then your fund's investment will be destroyed and the CEO will have civil and possibly personal criminal liabilities for years.

It's one thing when the customers can simply chose not to buy, it's another when they have to chose not to die. Seems to me there's a basic human right that could be enunciated here.
posted by bonehead at 2:33 PM on August 24, 2016 [2 favorites]


I just had a quick flick through the BNF, and there are three different brands of epipen-style devices available in the UK: actual Epipens, Jext pens, and Emerade pens. All cost between £23-26 for a two pen package.

So what hurdles does the FDA put in the way of Jext and Emerade which stops them being approved in the US? They've been approved by the MHRA here which is pretty stringent, so the manufacturers are obviously able to demonstrate the safety of their devices. What extra hoops does the US system have?
posted by tinkletown at 2:39 PM on August 24, 2016 [2 favorites]


There are different, better refutations of the "US subsidizes the rest of the world" idea

Such as?
posted by tirutiru at 2:42 PM on August 24, 2016


LOL - Emerade is made by a Valeant sub. So i think we know the answer there...

There is a significant cost of getting the device approved by the FDA, and if on approval Mylan just immediately takes pricing back to 40 bucks a pen, then the ROI for the Jext owner just might not be there given they'd be starting from zero market share.

I'm sure Mylan knows that math like the back of their hand.
posted by JPD at 2:44 PM on August 24, 2016 [1 favorite]


Yeah, I’ve read that it costs at least a couple of $million to get FDA approval for your generic version of a particular drug or treatment. You have to be able to demonstrate that your drug (or delivery system) is equivalent to the original & that takes actual studies on the ground.

Which is a great barrier to entry - if all your potential competitors know that the reward for them spending multi-digit $millions on proving the equivalence of their treatment will be you cutting the price of your version to the point that they can’t make a profit, then none of them will bother to do the work & you get to reap the profits of your exclusive deal with the FDA in the meantime!

Once again, the US manages to occcupy the worst of all possible worlds when it comes to first world healthcare delivery systems.

JPD: Of course the EU pharma companies generate significant revenue in the US. But if that revenue dropped to the average of the rest of the first world, they’re hardly going to pack up their bags and go home are they? And that’s before we get into the whole “the US pharmaceutical industry spends more on advertising than it does on R+D” thing.
posted by pharm at 2:48 PM on August 24, 2016 [1 favorite]


Here in Australia, they are $37.50 with a prescription, thanks to our Pharmaceutical Benefits Scheme. America should give socialised medicine a try.
posted by robcorr at 2:53 PM on August 24, 2016 [6 favorites]


One easy fix that will take no time at all to implement: common approvals for drugs in the OECD.

The FDA (and EMA and MHLW and HC and TGA etc...) function as a protectionist barrier: yea or nay?
posted by bonehead at 2:54 PM on August 24, 2016 [4 favorites]


JPD: Of course the EU pharma companies generate significant revenue in the US. But if that revenue dropped to the average of the rest of the first world, they’re hardly going to pack up their bags and go home are they? And that’s before we get into the whole “the US pharmaceutical industry spends more on advertising than it does on R+D” thing.

Just rough super back of the envelope math says if the US paid a similar revenue/pop as western europe you'd basically halve profitability at the European pharma guys. There is some clawback from lower marketing expense, but not as big as you imagine. If you capitalized all of the R&D on that new profit number it would mean pharma is not a great business.

The FDA (and EMA and HC and TGA etc...) function as a protectionist barrier: yea or nay?
The do, but they've also added a duplicative safety net which prevented or limited some real tragedies.

Now maybe for an injector thats not the same issue.
posted by JPD at 3:01 PM on August 24, 2016 [1 favorite]


>> ever higher CEO salaries
> Can someone explain this from an economic standpoint? Companies are always trying to cut costs elsewhere - why such incredibly exorbitant salaries?


There was a short piece in the New Yorker years ago (before the latest raft of CEO pay articles in 2008/9) that talked about how most companies (before Kellogg & Post) used to be sole proprietorships or partnerships, but once companies started to be publicly funded and run by "professional" managers, embezzling was epidemic. The article is about how stock grants are supposed to convince CxOs that they're stealing from themselves, but high salaries can also provide a distraction from the company's money.

Pretty terrible that you have to bribe someone not to steal...
posted by morganw at 3:02 PM on August 24, 2016 [3 favorites]


> Pretty terrible that you have to bribe someone not to steal...

really the terrible thing is we're not all bribed not to steal.
posted by You Can't Tip a Buick at 3:28 PM on August 24, 2016 [3 favorites]


I'd like a straight ban pharmaceutical advertising. Think of the money they'll save by not trying to convince me that Viagra single packs are necessary to my existence while I watch Wolf Blitzer pretend to be a journalist on CNN. (Seriously, though, many Big Pharma companies spend more on advertising than they do on R&D, and their whining about needing to subsidize R&D by bilking Americans doesn't fucking fly.)
posted by xyzzy at 3:38 PM on August 24, 2016 [7 favorites]


You know the series finale of Seinfeld, when (spoiler alert) our heroes all end up in prison basically for being smug selfish assholes, in violation of Good Samaritan laws? This is the kind of thing I wish could be applied in real life to Heather Bresch, Martin Shkreli, maybe some Aetna execs...

By this logic, it seems that every med-pharma company that is not run as a non-profit is a criminal cartel.

If it quacks like a duck...
posted by Roommate at 3:40 PM on August 24, 2016 [1 favorite]


Yea, it really wasn't that long ago they couldn't advertise. Guess who's administration that occurred under?
posted by Strange_Robinson at 3:41 PM on August 24, 2016


I can remember it changing, but can't remember when. That indicates that probably it happened under Clinton I.

and yeah upon actually googling it, Clinton I is more or less the right answer. though to be fair the very first direct-to-consumer drug ads happened under Reagan I (may there never be another).
posted by You Can't Tip a Buick at 3:53 PM on August 24, 2016 [1 favorite]


Here in Australia, they are $37.50 with a prescription, thanks to our Pharmaceutical Benefits Scheme.

I've been to the local pharmacy and bought a pair of them for about $125 each - I didn't have a subscription. I guess that's the cost price to the government?

I was grey importing them for people in Malaysia - Epipens are literally not available for any price in that country. It's a combination of high costs and low shelf life that made it not viable for any wholesaler to import them since about 2012.

I guess people with severe allergies just die there?
posted by xdvesper at 4:11 PM on August 24, 2016


The FDA (and EMA and MHLW and HC and TGA etc...) function as a protectionist barrier: yea or nay?

It turns out that the drug companies kind of agree with you on this one.
posted by Kid Charlemagne at 4:30 PM on August 24, 2016


it wouldn't be possible to dismantle a pharma corporation overnight, and resume production at the old prices the next day.

Sure you can. There is no practical reason this couldn't be done. The FDIC bank regulators did it over a thousand times back in 2009. They go in on a Friday, close the doors, run out all of the top management and re-open on Monday with a new temporary sign over the door. The bank's customers might not even notice the change.

Obama did the same with GM, one of the largest and more complex supply chain companies in the country. GM went right on making cars throughout.

If you say it is a legal issue, then that is a different matter and a subject of politics, not some physical or economic barrier.
posted by JackFlash at 5:19 PM on August 24, 2016 [7 favorites]


I found this article discussing Teva's true "generic EpiPen," from February, illuminating (obnoxiously register-walled but free). Some highlights:
  • The FDA has a huge backlog of generic drugs to approve.
  • Mylan funded a study trying to argue that small differences in generics confused patients and could lead to incorrect dosing. The FDA hasn't been super sympathetic to Mylan, but may have still been influenced by this
  • The Auvi-Q recall may have also led the FDA to be considerably more cautious about approving a generic
  • A quote: "And will the FDA require a Risk Evaluation & Mitigation Strategy (REMS)? A major part of the FDA review may be to determine if a cheaper generic outweighs the risks of the potential misuse of an emergency and potentially life-saving drug"
  • This was before the FDA bounced their application citing "major" deficiencies; couldn't find any more specific info on what those were so can't say whether it was dosing inaccuracies or a confusing design or what
posted by en forme de poire at 5:24 PM on August 24, 2016 [3 favorites]


I'm generally fairly left-wing, but also believe that free-markets can have a lot of benefits.

Given that EpiPens from the same company and from the same factory are sold in every country in the world for one-fifth the price of the U.S. you would have to admit that there is something uniquely screwed up in the form of "capitalism" as practiced in the U.S.

You can start with the fact that pharmaceutical lobbyists have made it illegal to buy an EpiPen in Canada for $50 and bring it into the U.S.

These market failures aren't just some happenstance. They are actively created by political manipulation in order to distort markets, steal from consumers and enrich the powerful.
posted by JackFlash at 5:31 PM on August 24, 2016 [20 favorites]


I had a somewhat similar conversation with a coworker the other day about the exuberant cost of healthcare/medication in the US. I pretty much think it's immoral that in this day and age people are dying from things that are completely treatable - because they couldn't afford the proper care or medication. It's not like we are living in the Dark Ages where you get, like a terrible allergy attack or something, but it's again it's the Dark Ages, so no one knows what's wrong with you and they are like "WELL IT'S IN GODS HANDS MAYBE PRAY AND YOU'll LIVE". NO. We have MODERN MEDICINE and we know what's wrong with you and know how to fix it but, hey, no money? Sorry. Hope you have enough money for a proper burial or you'll be tossed into a paupers grave with Mozart.

Ok, that wasn't the exact wording to the argument at the time, but my coworkers response to my statement that it was immoral for making money off of peoples lives was that "well, we all die anyways". Yeah, get back to me when your kid or yourself are in dire need of an lifesaving operation but your insurance won't cover it and you can't afford it. Just wave goodbye, oh well.
posted by littlesq at 5:37 PM on August 24, 2016 [3 favorites]


>I'm generally fairly left-wing, but also believe that free-markets can have a lot of benefits.

>You can start with the fact that pharmaceutical lobbyists have made it illegal to buy an EpiPen in Canada for $50 and bring it into the U.S.


Following up on this, exactly what is free about a market in which you are not free to purchase a branded drug anywhere you want to?

We could fix almost all of these price gouging problems in the U.S. overnight if people could simply purchase branded drugs in the world free market.

But it turns out that people who talk about "free markets" don't really want free markets at all.
posted by JackFlash at 5:49 PM on August 24, 2016 [7 favorites]


(Seriously, though, many Big Pharma companies spend more on advertising than they do on R&D, and their whining about needing to subsidize R&D by bilking Americans doesn't fucking fly.)

Ugh, it's complicated though. On the one hand yes, direct-to-consumer and doctor marketing is awful and there's no doubt that part of what modern pharma companies do is "sell" people on the need for the drug they have. It's a bad incentive. On the other hand, it's also a real problem that drug-making is an inherently massively risky and expensive business. The average drug is phenomenally expensive to bring to market, because so many molecules fail somewhere in clinical trials (and the further they get, the more money they suck up with zero return). Whether you believe the figure is closer to $1bn or $100m depends on who you believe but it's definitely in that regime.

Some people have rightly noted that nonprofit drug makers have been able to develop drugs more cheaply, but it seems to me like a lot of their successes were kind of low-hanging fruit: stuff like fine-tuned combination therapies of drugs that already existed and were already approved. That's still awesome work and necessary to make treatments that are safer and cheap enough for the developing countries that are dealing with these neglected diseases -- but at least to me, it doesn't seem like a fair comparison to bringing an entire new molecule through the process. (Rohit Malpani also quotes Andrew Witty correctly but misleadingly. When Witty called the $1bn figure a "myth" he just meant that it is an average over drugs, most of which fail, and that by changing research methods you might be able to get that figure lower. But he didn't mean that the average is actually wrong.)

Anyway, that, combined with the resulting amount of pathological incentives that these constraints create, strikes me as a reasonable argument for socializing drug development, like we've done with a lot of basic research (which is of course, even riskier) -- but good fucking luck with that. And knowing America we would probably end up being some ghastly private-public partnership, with eight unaccountable layers of consultants advising contractors who hire consultants to advise subcontractors. Or else we'd just see the NIH and NSF evaporate.
posted by en forme de poire at 5:56 PM on August 24, 2016 [1 favorite]


I really don't see the need for "free markets" in healthcare. It's just crazy watching all these patchwork solutions being offered -- buy from Canada! increase competition! more websites with more info! add a "public option"! -- when it's pretty clear the fundamental problem is offering necessary life services through capitalist free markets. That's just not what they're suited for. It makes no sense for health, for roads, for fire departments, police, money, water, defense, pensions, education, communication infrastructure, much of transportation and housing, and about a million other things. At this point I really don't see what markets are especially good at, apart from trinkets and minor luxury goods. The idea that socialism (real socialism, not Sanders' socialism-lite) doesn't technically work seems to be based on control theory from the 1950's; I imagine we could socialize just about everything now and do it perfectly well. But sure -- leave the capitalists their playground of iphones and $200 jeans and silly restaurants. But at this point by default it would seem that the vast majority of things we buy, most of which are necessary for life (housing, health, food, transportation, etc) should just be taken out of the destructive hands of the market and put into the hands of democracy.
posted by chortly at 6:23 PM on August 24, 2016 [13 favorites]


My allergist makes be by them even though I never would react that badly to dust or pollen to need it. Even with insurance, it's $150. I gave mine to my cousin who really needs it.
posted by shawnmcnulty at 6:42 PM on August 24, 2016 [1 favorite]


Can a corporation be dissolved by executive action in the US? I mean, drone-based executions of citizenry are generally seen as acceptable...
posted by Jessica Savitch's Coke Spoon at 6:54 PM on August 24, 2016 [3 favorites]


Can a corporation be dissolved by executive action in the US?

Just induce the corporation to flee to a politically unstable 3rd world country, and then everything's niiiiiice and legal.
posted by indubitable at 7:07 PM on August 24, 2016


In similar news: Good Lord. Even the Price of Insulin Is Skyrocketing.
[...] A study published by the Journal of the American Medical Association in April found that between 2002 and 2013, insulin's cost had leapt by more than 200 percent, from $231 to $736 per patient annually.
posted by Joe in Australia at 7:22 PM on August 24, 2016 [2 favorites]


Pharmacy benefit managers, which handle prescriptions and negotiate with drugmakers on behalf of insurers, are another likely culprit. These companies often receive commissionlike “rebates” from drug producers that may be encouraging them to buy more expensive products for their clients, as Kasia Lipska noted in the New York Times in February.

omg fuck everything
posted by en forme de poire at 8:56 PM on August 24, 2016 [5 favorites]


Mylan cuts EpiPen costs after public outrage over price hike -- Sort of
The company said it would reduce the patient cost of EpiPen through the use of a savings card, which will cover up to $300 of EpiPen 2-Pak.
. . .
For patients previously paying the full amount of the company’s list price, the card effectively reduces their out-of-pocket cost exposure by 50 percent, Mylan said.
posted by Kirth Gerson at 5:42 AM on August 25, 2016


Sort of

Sort of is right. They are making them more affordable to (some) individual buyers, but the list price is staying high for schools, hospitals, the fully insured, etc.

How many times do we have to see the same immoral price gouging before we regulate pharmaceuticals a bit differently?
posted by Dip Flash at 6:55 AM on August 25, 2016 [3 favorites]


Adrenaclick hasn't been discontinued, I know people who have one on them or at least nearby 24/7. It works a little differently but I think many people could switch. Something to look into given the insane prices and greed going on elsewhere.
posted by aerotive at 7:47 AM on August 25, 2016


A quick and simple solution is to allow people and insurance companies to buy their EpiPens from mail order pharmacies in Canada. Once people started doing that, Mylan would quickly lower the price in the U.S. The only reason you can't is because pharmaceutical companies write the laws.
posted by JackFlash at 8:04 AM on August 25, 2016 [2 favorites]


It sounds like the real problem is that the old Epi-pen pricing wasn't high enough to entice someone in to the market, so Mylan has figured out he best way to maximize their economic returns is to crank prices sky high for the few years it takes someone else to get an injection device to market.

The more I read on this though, that doesn't appear to be the case. There are a number of attempted entrants into the market and a number of similar products available elsewhere. The common bottle neck appears to be the FDA slow pace a approving generics, and technical guidance by the FDA which don't allow substitution of one product for another and so aren't covered by insurers (this is Adrenaclick's problem).

IOW, this looks less like a true economic cost-of-entry barrier, and more like one entirely due to regulation. And not primarily cost factors, but one of time to market induced by regulatory delays.
posted by bonehead at 9:04 AM on August 25, 2016 [1 favorite]


Following up on this, exactly what is free about a market in which you are not free to purchase a branded drug anywhere you want to? But it turns out that people who talk about "free markets" don't really want free markets at all.

I'm specifically talking about domestic free markets. International trade is a much more complicated issue because of patents.

Don't put words in my mouth.
posted by schmod at 10:44 AM on August 25, 2016


I'm not familiar with how medical device patents work, but would it be possible/legal for a "generic" manufacturer to produce a device that was mechanically-identical to an Epi Pen?

If not, can we call our senators, and lobby for laws that would allow that? The very same studies that Mylan funded seem to suggest that standardization and uniformity among medical devices could save lives.

I actually find their argument compelling here. Lifesaving devices are far more effective when they have a standardized design. The answer is not to ban competing devices that are similar to an Epi Pen -- the answer is to allow the competing devices to sail through [this portion of] the approvals process if they're identical to an Epi Pen.
posted by schmod at 10:52 AM on August 25, 2016


the answer is to allow the competing devices to sail through [this portion of] the approvals process if they're identical to an Epi Pen.

This is impossible. Mylan (on edit: a business partner actually) does have at least one patent current on the injector, a cap system, according to this report: "...EpiPen is protected by patents on the device, particularly the safety cap on the needle. The patents are held by Meridian Medical Technologies, which is now part of Pfizer. One such patent, which was asserted in litigation trying to block Teva’s entry into the market, expires in 2025."
posted by bonehead at 11:03 AM on August 25, 2016


Pfizer is Mylan's partner, in case that's not clear. They're the distributor for the Epipen in many countries.
posted by bonehead at 11:06 AM on August 25, 2016


A reddit post talking about this same issue had a user creating a 3D printable mold to provide a lower cost option. Apparently the drug itself isn't too expensive, just the application method of the epi-pen itself.


There's no justice like internet justice. :-)

I will be sharing that link.
posted by prepmonkey at 11:09 AM on August 25, 2016


I have SO SO many comments I want to make in this thread, and all similar threads. I work for a major medical device manufacturer in the US, and I think I could contribute substantially to the conversation (even if I had to write paragraphs upon paragraphs to cover my points fully), but I'm afraid I'd get fired, even though our products are awesome and I don't think we're price gougy at all. =(
posted by sharp pointy objects at 11:17 AM on August 25, 2016 [2 favorites]


Incidentally, here's an NYT story from 2008 about the president of West Virginia University resigning in the wake of a media scandal around Heather Bresch (current CEO of Mylan) being awarded an MBA from that institution despite not actually having received enough credits to merit the degree.

As noted in the FPP, Bresch is the daughter of former West Virginia governor Joe Manchin.

(via atrios)
posted by You Can't Tip a Buick at 11:33 AM on August 25, 2016 [1 favorite]


When Martin Shkreli is calling you out for price-gouging on pharmaceuticals, you know you've fucked something up big.

At the same time, this is like when that on guy you know who always gets caught lying calls someone else out for being full of shit.

Or less charitably, that one really creepy guy reblogs some feminist post with "i believe women".

We all see what you're doing, dude.
posted by emptythought at 11:48 AM on August 25, 2016 [4 favorites]


Jim Wright has an Opinion.

The primary difference between Mylan and Shkreli is that Mylan (like most pharmaceutical companies) has every reason to keep their customers alive, heathy, and happy. Dead people don’t buy Epipens.

Shkreli had no such interest.

posted by Johnny Wallflower at 3:03 PM on August 25, 2016


Jim Wright, whoever that is, completely ignores the role of regulatory bodies here, and how they have manipulated and been manipulated to influence prices. This isn't just ECO 100 level theorizing about free markets.
posted by bonehead at 3:27 PM on August 25, 2016 [1 favorite]


When I was first prescribed an epipen back in 2005, I had no insurance and it cost me $120 for two of them, which was a very difficult amount of money for me. Currently my insurance is fairly kind about covering them (they gouge me on a lot of other things though), and with it I pay $20 for two and need to refill about every year and a half. I know a lot of people who need to carry an epipen more than I do who can't afford it, because in addition to not having the cash to pay for it, they also cannot afford a doctor's visit to get it prescribed.
posted by bile and syntax at 4:06 PM on August 25, 2016 [1 favorite]


Currently my insurance is fairly kind about covering them ... and with it I pay $20 for two and need to refill about every year and a half.

While it is nice that you can afford your EpiPens, the fact remains that you, me and everyone else are picking up the hundreds of dollars for the actual cost of the EpiPens in increased insurance premiums. Price gouging, even if hidden by insurance, is a cost to everyone in our health system.
posted by JackFlash at 5:25 PM on August 25, 2016 [2 favorites]


My point was not that I can currently get them, but that the barriers for many people are functionally even higher than the outrageous price tag.
posted by bile and syntax at 7:08 PM on August 25, 2016


Schmod, that's exactly what Teva is trying to do. The FDA bounced their application so they'll probably resubmit for a 2017 release.
posted by en forme de poire at 7:53 PM on August 25, 2016 [1 favorite]


Speaking to a friend the issue with the Teva device isn't even if it works, but rather if it can look feel and operate like an Epi-Pen w/o violating the patent Mylan has on the device.

Basically it has to pass a test of "Would a casual user of an EpiPen view the injecting process as exactly the same, while an expert/IP lawyer can argue it actually isn't"

Which is just a bizarre standard.
posted by JPD at 6:09 AM on August 26, 2016 [2 favorites]


Excuse my language, but how the fuck is the patent valid until 2025? US Patents are valid for 20 years from date of filing. In practice, it's much shorter for medical/pharma stuff, because the first few years of the patent are "wasted" on the approvals process.

Epi Pen was on the market since well before 2005.

Either Mylan changed the design very recently (calling their arguments about consistency into question), or the patent is bullshit. Either way, their explanation reeks, and the NYT just printed it at face value. Ugh.
posted by schmod at 7:59 AM on August 26, 2016


Which is just a bizarre standard.

I think the FDA needs to clarify what's happening here. They seem primed to only allow an EpiPen or an exact copy to market.

There are at least two other autoinjectors that are allowed in Europe, Jext and and Emerade, but they don't work exactly like the EpiPen either. Presumably that's why they appear not to have even applied to the FDA.
posted by bonehead at 8:01 AM on August 26, 2016 [1 favorite]


how is the patent valid until 2025?

EpiPen filed a new patent on their redesign in 2003, which would expire in 2024. That is one of the ways drug companies extend their "limited" monopolies indefinitely by making small changes in the original patent.

The patent system for drugs is a big part of what is wrong with healthcare in the U.S. There are much better ways to develop new drugs than a patent system that awards a market distorting monopoly to drug companies.
posted by JackFlash at 8:15 AM on August 26, 2016 [1 favorite]


NYT: Painted as EpiPen Villain, Mylan’s Chief Says She’s No Such Thing
In the interview, Ms. Bresch said the company’s latest actions would do the most to help patients where it mattered, by reducing their out-of-pocket costs. And she said that the $600 list price was necessary for the company to recoup its investment in the EpiPen, which includes raising awareness for severe allergic reaction and making improvements to the way the product works.

But she also sought to shift blame away from Mylan, saying that patients are feeling the pain in part because insurers have increased the amount that customers must pay in recent years.

“What else do you shop for that when you walk up to the counter, you have no idea what it’s going to cost you?” she said. “Tell me where that happens anywhere else in the system. It’s unconscionable.”

To some, the company’s response seemed to ring hollow. “It’s a real challenge to understand how a management team sits around a board table and makes a decision to raise the price of a lifesaving medication over and over and over, and when the P.R. storm hits, decides to blame someone else for that price increase,” said David Maris, an analyst for Wells Fargo. He had warned investors in June that Mylan’s price increases on EpiPen and other drugs could soon draw unwanted media scrutiny.
posted by Existential Dread at 10:00 AM on August 26, 2016


And some commentary on the patent and regulatory issues facing generics, including the massive backlog on generics at the FDA.
posted by Existential Dread at 10:07 AM on August 26, 2016


And she said that the $600 list price was necessary for the company to recoup its investment in the EpiPen, which includes raising awareness for severe allergic reaction and making improvements to the way the product works.

Sure, that sounds legit.

But she also sought to shift blame away from Mylan, saying that patients are feeling the pain in part because insurers have increased the amount that customers must pay in recent years.

“What else do you shop for that when you walk up to the counter, you have no idea what it’s going to cost you?” she said. “Tell me where that happens anywhere else in the system. It’s unconscionable.”


This is pretty great misdirection and borderline concern trolling. She's absolutely right that a 3rd-party insurer system completely insulates patients and healthcare providers from knowing the real cost of things, and this is one of the fundamentally fucked up things about the system. We're leery of saying cost should be a concern in healthcare decisions, but if two bottles of pills work equally well and one has a time-release and a $300 higher price tag, well, that's an important consideration. Taking one pill a day instead of two is not worth $300.

She is of course conveniently leaving out the part where her industry has been basically waging a war to encourage patients to go for exorbitant drugs over generic alternatives and painting the insurance company as a bully for not wanting to cover a vastly more expensive drug that has little-to-no improved efficacy. Loyalty cards and coupons have been a major weapon they've used against insurance companies to counter higher copays, and it's frankly a brilliant strategy: "I'm trying to save you money on better things, but that big, faceless insurance company won't let me, boo!"

The other part she's leaving out is that this is the system we have, and the only way to fix it is to either socialize health insurance in this country or completely nationalize the healthcare system, both of which would be bye-bye year-round Christmas for her industry. I say we call her bluff.
posted by middleclasstool at 1:35 PM on August 26, 2016 [2 favorites]


Our drug profits are subsidizing world medicine. Its the biggest bullshit ever.
posted by Ironmouth at 12:45 AM on August 27, 2016


Our drug profits are subsidizing world medicine.

You are Donald Trump and I claim my £100.
posted by Joe in Australia at 2:41 AM on August 27, 2016 [1 favorite]


Our drug profits are subsidizing world medicine. Its the biggest bullshit ever.

Ah, yes. Spoken like a drug company lobbyist. They want Americans to believe they are paying the correct price and the rest of the world is ripping off the drug companies. They would like Americans to bully the rest of the world into paying higher prices through trade deals like the TPP.

Yes, it is Americans who are getting ripped off by the drug companies and it happens because of the drug company lobbyists write the laws to prevent free markets.
posted by JackFlash at 8:12 AM on August 27, 2016 [1 favorite]


Drug profits aren't subsidising shit. The income that is spent on R&D is spent, an outgoing, and not profit. Profit is the money that isn't invested.
posted by Dysk at 8:32 AM on August 27, 2016 [2 favorites]


I've heard that you can drive to Canada and buy a few of them. The trip itself, spending the night in as many Ritz Carlton hotels as you can, will save you money. Also, it is less expensive to fly to Australia, and pay for an MRI or CAT scan, out-of-pocket, than it is to just walk to the nearest hospital in the US.

Any Canadians and/or Ozzy's want to chime in, I am all ears as I've never actually performed either of the two suggested activities.
posted by Monkey0nCrack at 8:22 PM on August 28, 2016


NYT: Mylan to Offer a Generic EpiPen at Half the Price
The new move could help mollify critics, though some are likely to point out that even at $300, the generic would still be triple the price of the EpiPen in 2007, when Mylan acquired the product and began steadily raising its price from around $100 for a pair, with the price increases accelerating in recent years.
NPR: Maker Of EpiPen To Sell Generic Version For Half The Price
Mylan's latest move is meant to calm the anger of consumers and lawmakers, but it's may also be a shrewd business decision.

By bringing a generic to the market now, it could preemptively steal some market share away from Teva Pharmaceuticals, which is developing its own generic EpiPen. That device is expected to be approved in 2017.
posted by Existential Dread at 8:29 AM on August 29, 2016


EpiPen Maker’s Latest Offer: Still Not Good Enough (Robert Weissman, president of the consumer group Public Citizen - posted today on HuffPo, via NPR)
The weirdness of a generic drug company offering a generic version of its own branded but off-patent product is a signal that something is wrong. Mylan knows its $600 per set of EpiPens is unsustainable, but aims to continue ripping off some segment of the marketplace - both consumers who do not trust or know about the generic and perhaps some insurers and payers constrained from buying a generic. The announced $300 price for Mylan’s generic also comes in too high; the profitable price in Canada is roughly $200 for two, and the price in France is roughly half that.
Wash. EMTs using cheaper 'Epi Kit' instead of EpiPen
“Basically, we put together this kit that was cost-effective,” said James Duren, the professional-standards manager for King County Emergency Medical Services. “We made Epi Kits instead of EpiPens.”

The program is called “Check and Inject,” and since it was rolled out last year in 31 fire departments, Duren figures it has saved about $150,000 and more than doubled use of epinephrine by area EMTs.

...the epinephrine kits put together by King County cost about $10 each. When the small vials of drug expire after a year, they’re replaced for about $2.50 apiece, Duren said.

“It’s a kind of win-win all the way around,” he said. “The only person that doesn’t win is the maker of the autoinjector.”
Of course, Mylan is pitching the time you could save with their product, and some question EMTs drawing medicine as this is "a task typically reserved for paramedics."

And if you're looking at this as a DIY solution, Wonkette says Please Don’t DIY Your Own EpiPen! Your Snake Oil Bulletin. In short: it's likely you're not an EMT, let alone a paramedic or someone trained in preparing and administering life-saving medicine under stressful conditions.

My personal dream solution: mass-produced medical grade injector with an easy replace epinephrine pack. Then the only thing that is disposed annually is the medicine, and the hunks of plastic and metal can be kept in their cases for years.
posted by filthy light thief at 11:13 AM on August 29, 2016 [3 favorites]


mass-produced medical grade injector with an easy replace epinephrine pack

Novo Nordisk makes insulin injector pens that work this way. The replaceable cartridge consists of a cylinder with a small rubber sealing bead at the business end and a free floating rubber piston plugging the back; when you install a needle on the business end of the cartridge, the cartridge-facing end of the needle pierces the rubber bead to dip into the insulin inside.

I can think of no reason at all why an adrenalin injector every bit as reliable as an EpiPen could not be built along similar lines.
posted by flabdablet at 12:06 PM on August 29, 2016 [2 favorites]


If they halved the price 2 or 3 more times, I think many more people would be happy.
posted by ZeusHumms at 12:36 PM on August 29, 2016 [1 favorite]


Our drug profits are subsidizing world medicine. Its the biggest bullshit ever.

The company in question here, Mylan, doesn't do basic drug research. They bought the technology for the EpiPen from Merx, for example. They do have to pay off that purchase price, but they did not develop or shepherd the drug or their injector through the FDA.

They are, in general, a manufacturer of generics. They do have to get those certified by the FDA, but that's through the much cheaper Abbreviated New Drug Application (ANDA) not the longer and more expensive IND/Clinical trials/NDA process for brand new drugs.

High drug costs being justified or necessary to subsidize new research do not apply in this case, as Mylan doesn't do new drug development.
posted by bonehead at 1:14 PM on August 29, 2016 [3 favorites]


EpiPen maker gave CEO more than $5 million to cover personal U.S. tax bill

As usual, the scandal is what's legal.
posted by tonycpsu at 9:11 AM on August 30, 2016 [3 favorites]


EpiPen Tycoon Pokes Fun At The Dark Reality of Pharmaceutical Controversies
There are only three controls in EpiPen Tycoon. You can increase the price of an EpiPen by $5, reduce it by $5, or, in the rare occasions that the public gets too mad at you, deploy a few outrage-deflating special bonuses. The goal is simple: you, Heather Bresch, are the CEO of Mylan. You want to make as much money as possible by selling EpiPens. If your customers die, they die.
posted by tonycpsu at 7:05 PM on August 31, 2016 [4 favorites]




And the scandal gets wider as lobbying for EpiPen purchases by schools by a major school lobby coincided with Gayle Manchin taking over at the helm.

If that last name sounds familiar, it should - she's the wife of Senator Joe Manchin, and the mother of Mylan CEO Heather Bresch.
posted by NoxAeternum at 11:07 AM on September 20, 2016




Mylan CEO Claims EpiPens Aren't As Profitable As Everyone Thinks (NPR, September 21, 2016)
Mylan NV CEO Heather Bresch says it costs the company about $69 to make two EpiPens, and after rebates and fees, Mylan receives $274 per EpiPen pack. She says other, unnamed costs absorb an additional $105, leaving $100 in profit for the company.

While the company apparently is looking to use the analysis to downplay its profits, analysts say the margin is still quite high.

Ronny Gal, a pharmaceutical industry analyst at the investment firm Sanford Bernstein, says Bresch's numbers mean Mylan makes a 40 percent profit margin on the device.
...
The wholesale price of a single pen was about $47 in 2007...
...
In her testimony, Bresch says the company did not intend for its price hikes to hurt patients.

"Looking back, I wish we had better anticipated the magnitude and acceleration of the rising financial issues for a growing minority of patients who may have ended up paying the full [Wholesale Acquisition Cost] price or more," she says. "We never intended this."
Ooh, so you thought insurance companies would swallow that cost, and no one would notice what you're charging for a fooking generic drug in a fancy case.
posted by filthy light thief at 1:12 PM on September 22, 2016 [3 favorites]


Still, Mylan is somehow doing something wrong, as Bloomberg reported that in France, where Meda sells the drug, two EpiPens cost about $85 and if you get them from a brick-and-mortar shop in Canada, you'll spend about $80 each in U.S. dollars, or $160 for two, 58% of Mylan's $274 for a two-pack (Consumer Reports, August 31, 2016). Each country may subsidize the cost of these drugs, or the companies may have a more efficient process (or actually care about cutting costs on what is a lucrative drug in the US).

CR also notes that if you're in the US, you can ask your doctor to write a prescription for an "epinephrine auto-injector" or "generic Adrenaclick," because doctors and pharmacies generally don't connect these generic options with the EpiPen for some reason. One person's charge to $60 co-pay after insurance, and
A Walmart pharmacy in White Plains, N.Y. told our secret shopper that a two-pack of generic Adrenaclick would cost $606, but when we asked about discounts, they told us they would accept the GoodRx coupon, bringing the out-of-pocket cost down to $140. CVS said it would also accept discounted coupons. The manufacturer offers a co-pay coupon to lower the price if you use your insurance.
(Consumer Reports, August 24, 2016)
posted by filthy light thief at 7:57 AM on September 23, 2016 [1 favorite]


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