EpiPen price spike leaves St. Louisans with few options

By:  Durrie Bouscaren
St. Louis Public Radio

Ever since her 6-year-old son was diagnosed with a severe peanut allergy, Oakville resident Maureen Walkenbach has kept EpiPens around at all times. One set stays at home in a cabinet, one goes with her kid to school, and one stays in her purse when they’re out and about.

“If [he’s] having trouble breathing, you have about four minutes,” she said. “These EpiPens, I can’t drive that home enough. We have to have them.”

Like thousands of other parents, Walkenbach is amazed by the rising cost of the device. Mylan, the maker of EpiPen, has pushed the cost from about $100 in 2008 to more than $600 today. The most recent cost increase has fueled accusations of price gouging as Mylan enjoys its last months of a near-monopoly before new competitors are set to enter the market.

For Walkenbach, that debate hit home when she tried to refill her son’s prescription for EpiPen Jr. at a Sam’s Club and was faced with a sticker price of $677.38.

So far, Walkenbach’s meticulous monitoring of her son’s food intake has kept her from having to use an EpiPen. But the injectors expire every year, and have to be re-purchased. The Walkenbachs have health insurance, but recently switched to a high-deductible plan. Even with a patient assistance coupon from Mylan, Walkenbach was on the hook for more than $500 for one EpiPen set — a cost she said she’s willing to pay, because going without it would be unthinkable.

Instead of three pairs of EpiPens, Walkenbach said the price is forcing her to make do with two — switching one from her kitchen cabinet to her purse whenever she leaves the house. When she forgets it, as she did on a recent trip to the grocery store, she rushes home in a panic.

Defending the price increases, Mylan CEO Heather Bresch told the New York Times, “I am running a business. I am a for-profit business. I am not hiding from that.”

That comment stung, Walkenbach said.

“I just — selfishly, I guess — wish that some of these medications wouldn’t have to be part of a business,” Walkenbach said. “I don’t want anything for free, but I also don’t want people to have to change their budgets and change their savings.”

In response to public outcry in recent days, Mylan has increased financial assistance for patients and promised to release a generic version of the drug in several weeks, which it says will be listed at $300. Like EpiPen, the generic version will be produced in St. Louis-area facilities operated by Meridian Medical Technologies, the Post-Dispatch reported.

“Because of the complexity and opaqueness of today’s branded pharmaceutical supply chain and the increased shifting of costs to patients as a result of high deductible health plans, we determined that bypassing the brand system in this case and offering an additional alternative was the best option,” Mylan CEO Breschwrote in a statement.

In the meantime, U.S. Sen. Claire McCaskill, D-Mo., has requested documents and a briefing from Bresch to discuss the EpiPen price increases.

“These pharmaceutical companies have said, ‘Well it’s not the consumers that are paying; it’s the insurance companies.’ Then we wonder why insurance rates are going up,” McCaskill said during a conference call with reporters. “Of course we’re paying.”

About 200 people in the United States die of anaphylactic shock every year, and the rate has stayed steady in the past decade, according to a 2013 study in The Journal of Allergy & Clinical Immunology.

To Washington University allergist Dr. H. James Wedner, the biggest problem lies in just how few alternatives there are for people with severe allergic reactions. EpiPen’s main competitor, Auvi Q, was recalled last year. There are other auto injectors, but they aren’t sold as widely and may work slightly differently.

Some patients choose to purchase syringes and vials of epinephrine to inject it manually, but that can be risky, Wedner said.

“There’s no way that we can expect a patient or parent to break open vials, draw up the correct amount, inject into somebody who is rapidly getting sick, calling 911 all at the same time," he said. "It just is not appropriate."

For Wedner, Mylan’s decision to increase financial assistance and create its own generic avoids the real solution.

"To me, until I see it, this is just another way of avoiding doing what should be done, which is to decrease the price," Wedner said.