EpiPen Drama and The Unveiling of Pharmaceutical Greed

Image of EpiPen Auto-Injector by Greg Friese

“How many patients will die because of this?”. I find myself asking this question whenever I discover another drug that pharmaceutical companies have slowly, but steadily been gouging.

Less than 6 months ago, we discovered that Martin Shkreli increased the price of Daraprim by 5000% overnight, hoping that nobody would notice. Well, people definitely did! The millions of patients with cancer or HIV that have compromised immune systems who need this drug to treat life threatening fungal infections definitely noticed.

More recently, the pharmaceutical company Mylan has been highlighted by the media for the incremental increase of the cost of EpiPens, a device that delivers the life saving drug epinephrine to those suffering from life threatening anaphylactic allergic reactions. In less than a decade, the company has raised the cost of this life saving drug from a retail price of $100 to over $600. Although the increase in price may not have been as rapid or egregious as Shkreli’s actions, the end result was the same: Many Americans being unable to afford this life saving medication.

To put things in perspective, according to the Asthma and Allergy Foundation of America, there are about 200,000 food allergy related visits to the ER each year with about 10,000 of these visits requiring hospital admission. These visits are likely to be by people with anaphylactic reactions to their allergen. This means that if one’s body is exposed to a culprit allergen, he or she could experience rashes, decreased blood pressure, swelling of the face, and worst of all, swelling of the throat leading to the inability to breathe and eventually death. In these situations, it is imperative to administer epinephrine quickly in order to prevent this sequelae of symptoms. Unfortunately, besides receiving this dose in the emergency department (which could be delayed for many logistical reasons), EpiPens are currently the only FDA approved devices that can administer this life saving drug. More importantly, timely administration of this medication could literally mean the difference between life and death.

Over the past decade, Mylan has strategically been building brand loyalty through advertising and lobbying. For example, they have lobbied aggressively to put EpiPens in schools all across the nation, and have simultaneously given away hundreds of thousands of Epipens away to schools as well. This effort has helped make the EpiPen a trusted household name and the main device doctors prescribe to patients suffering from anaphylactic allergies, all of which has certainly helped Mylan’s profits.

In addition to efforts to build brand loyalty, Mylan has the only FDA approved device to deliver this medication. With no other competitors to challengers their prices, they have been able to operate like a monopoly. They have charged however much they want and people have no other choice but to pay. However, the company recently settled a lawsuit to allow for generics to enter the market starting in 2015, so they are expecting a drop in their profits once an approved generic hits the market. Which is likely the reason for their more recent price surges.

Mylan initially started making bi-annual 10% price increases for the EpiPen in the early 2000s, but starting in 2014 they started making bi-annual 15% price increases. It is very likely this trend would have continued if consumers and the media had not started publicly criticizing the company. In various news reports, they claim that the increase in the price is largely due to the increase in the manufacturing costs to produce the device that administers the epinephrine. Interestingly, industry insiders estimate the full cost of an EpiPen at about $30. Even though there are always several middle men deals struck that will inevitably increase the price of the product, does this justify raising the price up to $600 retail price?

Sadly, this increase in prices is also correlated with the salary increases of Mylan executives as well. During this same period of time, many sources have claimed the CEO’s salary has also soared, reaching a high of $18 million in 2015. Unfortunately, cases like this continue to remind us that the goal of any corporation is to maximize profits, even if this goal is at odds with the health and wellbeing of patients.

For those well off, this is likely a non-issue. They will either just fork over the money for the device, or insurance will likely cover it. However, for the numerous uninsured or underinsured Americans, or those living paycheck to paycheck on a tight budget, this becomes a risky game. People often have to make a choice between buying an epi-pen or putting food on the table. As an emergency medicine resident at a public hospital, I have seen families in tears because they can’t afford these devices for their children. Even though Mylan has promised a generic version of this drug to hit the market soon, what should poor families do until that point?

I often ask if there will ever be an end to this madness. Sadly, I’m unsure. We live in a country where healthcare is run as a business (whether pharmaceutical or insurance industries), and philosophically, the goal of a business is to maximize profits and make investors happy. Many will tout the breakthroughs of our healthcare systems and make the argument that money drives innovation, research, and efficiency. But what is the point of discovery if those who need these treatments the most are either unable to afford it, or are living in excessive debt in order to purchase these drugs. How sustainable is this current system that we have, and is public shame the only avenue we have to curtail these prices?

Unfortunately, there will be many individuals and families who will not always have the luxury to wait for public outcry, and there will be some lives lost because of this corporate greed.

Abdulkareem Agunbiade is a Comedian, Emergency Medicine Resident, and Blogger. Follow him on twitter @AKtellsjoke.