The Free Market!


Poor Heather Bresch. She had good reasons for quadrupling the price of an essential life-saving device.

epipen

Comments

  1. Matt G says

    Striking a blow for feminism by showing that a woman CEO can be just as big an asshole as any man CEO!

  2. slithey tove (twas brillig (stevem)) says

    reminded once more of Oliver’s delicious take down of the pharmaceutical industry in America, which unlike pharmaceuticals in the rest of the world, are considered profit centers with a captive customer base.
    The only justifiable criticism of obamacare is how loosely it regulates the pharmaceutical industry (by failing to regulate its price structure).
    We (FDA) does a fine job ensuring the drugs are safe and effective, but let prices go unchecked.
    Optimistically this EpiPen think might motivate some additions to the FDA powers.
    Free Market is great, except when it isn’t. *mic drop*

  3. brett says

    There’s a very similar generic epinephrine auto-injector called Adrenaclick, which is available at a much lower price (around $150 at Walmart). It’s strange that EpiPen can command such a high price premium in that situation – has anyone tried out both and noticed a major difference?

  4. Nerd of Redhead, Dances OM Trolls says

    The only justifiable criticism of obamacare is how loosely it regulates the pharmaceutical industry (by failing to regulate its price structure).
    We (FDA) does a fine job ensuring the drugs are safe and effective, but let prices go unchecked.

    The FDA never has had the power to even influence drug pricing. They are barred by law at looking at pharma financials. Talk to and blame Congress about that lack.
    Also, blame Congress for the inability of government run health care to negotiate the price of drugs.

  5. drst says

    @slithey tove

    The only justifiable criticism of obamacare is how loosely it regulates the pharmaceutical industry

    yeah, no, there are a lot of justifiable criticisms of the ACA. Opponents just tend to not use them in favor of bullshit accusations.

  6. borax says

    Holy shit! Bresch actually claimed that the absurd increase in price improves access to epipens. Either she is the boldest liar that ever lied, or she is so privileged she can’t tell the difference between 60 and 300 dollars.

  7. qwints says

    We’re not sure, but it’s probably Obama’s fault.

    The government could have prevented it, but not Obama.

    The FDA doesn’t allow the much cheaper generic substitute as an authorized genereic.

    For example, the EpiPen Auto-Injector requires the removal of only one cap to prepare for administration, while the authorized generic epinephrine autoinjector requires the removal of two caps.

    http://www.pharmacytimes.com/p2p/p2pepinephrine-0910

    And they denied an application from the manufacturer of another generic.
    http://www.bloomberg.com/news/articles/2016-03-01/mylan-s-epipen-gets-boost-as-fda-spots-holes-in-teva-application?cmpid=yhoo.headline

  8. The Other Lance says

    @#3, brett, I don’t think AdrenaClick is considered a “generic” for the EpiPen. Both provide the same medicine, but the delivery mechanism is slightly different and you can’t request AdrenaClick as a ‘generic’ recplacement for EpiPen. You need a different script. EpiPen has one cap you remove, then inject into your thigh. The AdrenaClick has two caps to remove before the injection.

  9. says

    Cross posted from the Moments of Political Madness thread:

    From Sarah Kliff, writing for Vox, some thoughtful analysis of the EpiPen price gouging scandal:

    […] The story of Mylan’s giant EpiPen price increase is, more fundamentally, a story about America’s unique drug pricing policies. We are the only developed nation that lets drugmakers set their own prices, maximizing profits the same way sellers of chairs, mugs, shoes, or any other manufactured goods would.
    In Europe, Canada, and Australia, governments view the market for cures as essentially uncompetitive and set the price as part of a bureaucratic process, similar to how electricity or water are priced in regulated US utility markets.

    Other countries do this for drugs and medical care – but not other products, like phones or cars – because of something fundamentally unique about medication: If consumers can’t afford the product, they could have worse odds of living. In some cases, they face quite certain odds of dying. So most governments have decided that keeping these products affordable is a good reason to introduce more government regulation. […]

    http://www.vox.com/2016/8/23/12608316/epipen-price-mylan

    Read more: http://freethoughtblogs.com/pharyngula/2016/08/07/discuss-moments-of-political-madness-5/#ixzz4IS5LTnAj

  10. Saad says

    brett, #3

    There’s a very similar generic epinephrine auto-injector called Adrenaclick, which is available at a much lower price (around $150 at Walmart). It’s strange that EpiPen can command such a high price premium in that situation – has anyone tried out both and noticed a major difference?

    That’s true of almost all medications in general. Brand names sell for a much higher price because the companies want to recover all the money that went into the research and development stages. Generic manufacturers don’t have to do a lot of that because the medication has already been developed. They just have to get their generic formulation approved.

  11. redwood says

    @9 Lynna, OM Just to add my two yen’s worth, the Japanese government also regulates the cost not only of drugs but all medical procedures. No medical bankruptcies here.

  12. multitool says

    I skimmed Bresch’s reasons for the price hike and couldn’t find anything that could be called a ‘reason’, or even a rationalization. Am I missing an Easter egg somewhere?

    I too, don’t understand how raising the price of an object increases its availability. Some kind of economics jiu jitsu? Just weird gibberish? Rich-person-bubble-world groupthink?

    She does put on a show of being very concerned about the high prices, which feels like a mugger being concerned over the deadliness of the gun he’s pointing at your neck.

  13. davidnangle says

    Mental note: Another added to the list of… if I find them being rolled over, feet first, by an out-of-control steam roller, quickly jump into the driver’s seat and SLOW IT DOWN.

  14. blf says

    An article I read in I think it was the dead-tree edition of the International New York Times said something to the effect that if a specific named product is prescribed then that specific product must be provided, not a generic. Apparently, many(? most?) inhaler prescriptions say “EpiPen” and hence that is what the pharmacy must provide — and the patient pay for. I vaguely recall the article saying this rule is peculiar to USAllmineminemine (that is, in other countries a generic can be provided).

  15. qwints says

    @blf, it’s state by state. Where I live allows substitution of “authorized generics” but that’s not true everywhere.

  16. qwints says

    strike that – actually it allows pharmacists to substitute all therapeutic equivalents.

  17. Saad says

    blf, #16

    The prescriber actually has to explicitly say they want the brand name dispensed. It is assumed that generic substitution will be made by the pharmacy.

  18. erichoug says

    So I know that I have gotten crosswise with some of you but this is one that I have a close personal association with. No, I don’t use EpiPens. But, I do use something similar. I was Diagnosed as a type 1 diabetic at the age of 27(yeah, weird time to get it) and I have been on insulin ever since.
    Currently I am taking Lantus and Novolog. The most fun part is every year when my company gets a brand new, insurance plan and I get to see how much staying alive is going to cost me this year. So, in early 2016 I went to re-fill my Lantus prescription for 90 days. Previously I had been paying around $100 which I, naively, thought was expensive. So, when I got presented a bill for $1,750 for a 3 month supply I was a little upset. Don’t worry I did eventually apologize for what I said to the Pharmacy tech, it wasn’t his fault. The Novolog went from again around $100 to right around $450 for a 90 day supply. But, the good news was the 90 day supply of the statin I take went from $60 for a 90 day supply to only $21. So I saved $39 to help offset the $2000 increase in my other medications (YAY!).
    I went to my HR department to talk to them about it and I got their best “We’re really sorry ‘bout that, pal” faces but in the end they didn’t do anything about it.
    Now, keep in mind, these aren’t medications that I take to improve myself or to prevent future issues, these are medications that I take to stay alive. There really isn’t a generic I can switch to for either one. So, my options are essentially to pay whatever the pharmacist says or to die.
    I make a fairly good living so this isn’t causing me to go on an all Ramen diet or to cancel the cable, so don’t feel like you have to feel bad for me. While it has affected my life, think about someone with 3 kids living on a $45K/year salary whose medication for their daughter(one of my nieces is also type 1) suddenly goes from $400/year to almost $7,000 a year. What exactly is that person supposed to do?
    I REALLY want to just go to a universal single payer. As an engineer, it all comes down to the numbers for me and when you look at the numbers for the US healthcare system compared to other countries like Canada, France and the UK it is absolutely asinine that we keep going even with what we have now. We should be smart enough take the lessons learned from other countries that have made this change in the last 50 years and come up with the best option for all of us.
    But, I suspect that we will not do so any time soon and that I will continue to be nothing more than a cash machine for the pharmacies and drug companies.

  19. robro says

    slitheytove — Calling ACA “ObamaCare” is buying into a Republican ploy. The Republican dominated congress had more to do with ACA than Obama. Even congressional Democrats had more to do with it than Obama. Steven Brill, author of America’s Bitter Pill, noted in an interview that Republicans and Democrats both got exactly what they wanted in ACA. Republicans, representing the pharmaceutical industry, wanted no price controls. Done deal. Democrats, as he described a “bunch of tort lawyers,” wanted no tort reform. So be it. That’s an oversimplification but I’m cynical enough to believe it’s relatively close to the reality.

  20. slithey tove (twas brillig (stevem)) says

    re @4:
    thank you for expanding what I left unsaid as a silent implication. sometimes I’m too terse.

    re @21:
    yes, I know “o___care” is a dogwhistle, but it has become such a common usage referring to ACA that it is more recognizable than ACA. sorry to continue propagating that slur. even as a TLA-obsessive, I hesitate to use less common TLAs. (oh, using less common TLAs will make them more common. gotcha)

    if i could edit, replacing the dogwhistle with ACA, I would. oops.

  21. The Other Lance says

    @21, erichoug, YOUCH. That’s a bitter pill to swallow. I have adult-onset type II diabetes and also take Lantus and Novolog. The copays have gone up over time, but nothing like you’ve experienced. I hope you are exploring avenues to help control those costs. I know some of the insulin manufacturers have coupons and rebate programs to help alleviate costs.

    Refusing and/or reducing coverage for long-term medicines such as insulin, and especially testing supplies (test strips, lancets, etc.) is a penny-wise and pound-foolish move. Helping diabetics and others suffering chronic illnesses _manage_ them so they avoid expensive medical consequences in terms of both cost and life experience is crucial.

    I *hate* the very concept of for-profit health insurance. It creates an instant conflict-of-interest between providing coverage to their customers and delivering profit to their owners/shareholders. I’m all for a single-payer health system.

  22. blf says

    Ok, here’s that article, and I did indeed misrecall some of the details, The EpiPen, a Case Study in Health System Dysfunction:

    The Adrenaclick, while still not cheap, is […] less expensive than the EpiPen. Some think it’s harder to use, though. It’s not on the accepted list for many health insurance plans. More important, few physicians think of it. Because of that, they write prescriptions for EpiPens. Since the Adrenaclick is not a generic version of the EpiPen, pharmacists can’t substitute one for the other. A prescription for an EpiPen must be filled with an EpiPen, regardless of what consumers might want.

    So it’s not “you cannot substitute a generic” as I misrecalled, it’s “you can only subsistent an approved generic version, and the only(?) available alternative is not a generic version of what was prescribed”.

    The entire article is worth reading, as is the link embedded in the above excerpt.

  23. Hairhead, Still Learning at 59 says

    I just checked with a pharmacy here in Canada. We don’t have Adrenaclick, only Epipen, so no competition. I can get a set of 2 Epipens for $145 USD, including tax and dispensing fee, or $72.50 each. That’s 24% of the US price. Does any poster here know what the prices are in, say, the UK, France, India, Japan, Thailand?

  24. brett says

    @24 blf

    Thanks for the information. It’s extremely strange that Adrenaclick is not on most insurance plans.

  25. zibble says

    The Republican dominated congress had more to do with ACA than Obama.

    In what sense was the Congress back then “Republican dominated”? The Democrats had a filibuster-proof majority in the Senate until Obama spent so long trying to get make sure Republican ideas got into the ACA that Ted Kennedy died.

    Let’s not let Republican obstructionism rewrite history, here. Obama fucked up the health care debate from the start, because he’s always been a hippy-punching corporate shill. The GOP has just gotten so fucking off the rails lately that we forgot all that.

  26. watry says

    I’m also a type 1 diabetic, and while I’m only on Humalog, I use an insulin pump because syringes only landed me in DKA all the time. I also have several comorbidities that are common in people diagnosed young–PCOS, a thyroid disorder, mental health issues. I’m also midway through seeing whether I have gastroparesis and possibly a heart problem. This is FRACKING EXPENSIVE.

    I’m coming up on 27 and live with my parents because I can’t afford to do otherwise even on a full-time paycheck. Pretty much everyone I know has a college degree but either works two jobs, has taken out loans, lives with a handful of housemates, or lives with parents because it’s absolutely impossible to do otherwise, and that’s WITHOUT health problems.

  27. says

    An article I read in I think it was the dead-tree edition of the International New York Times said something to the effect that if a specific named product is prescribed then that specific product must be provided, not a generic.

    Interesting.
    In Germany many health insurers (German healthcare is a moderately well-working public private mess) have a contract with a specific pharmaceutical company for medication that is available from almost everybody so your prescription usually says “Drug X, Dosage Y, Company Z” and “aut idem”, which means “or the same by any other company. Your doc has to justify if you need a specific brand (for example they are lactose free or something like that).
    Oh, my co-pay for three months of thyroxin is 5,50€…

  28. wzrd1 says

    We’ve been a bit lucky, five Lantus pens cost us $50.00 copay.
    As for the Epipen, a decade and change ago, it cost $50.00 cash. My wife carried one, due to her severe beesting allergy.
    As my insurance would likely not cover the damned thing today, here’s to the extinction of honeybees!

    Bresch has been hiding behind her daddy, the US Spenditmore, but even he’s hiding right now.
    For, it makes for shitty political capital when one hears of a child choking to death on phlegm, while their larynx swells shut and they die horribly.*

    *I cut a few phases of death by anaphylaxis, no need to give people nightmares tonight. Epinephrine 1:1000, diphenhydramine injectable and typically, prednisone are needed to stop a significant reaction.

    Whenever you hear a Libertarian go on about the wonderfulness of the free market curing all ills, remind that asshole of this instance of corporate greed.

  29. madtom1999 says

    #26 I should carry an epi-pen as I have a serious allergy to wasp stings. I am also incredibly forgetful so would need about 20 of them. i discussed it with my doctor and, having survived 50 odd years without a wasp sting I never bothered to get one. I believe it would come under the normal prescription price of £8.40 per item. As I have regular medication I have a card that gives me all my medicine for around £120 annual charge.
    The current UK government is desperate to move to the US system though.

  30. Intaglio says

    You know you are evil when even Martin Shkreli says you are a “vulture”

    The manufacturers of “Epipen” the life saving device for those with allergies have vastly increased the wholesale price since 2010 from about $60 to over $360.
    via NBC

    Martin Shkreli Weighs in on EpiPen Scandal, Calls Drug Makers ‘Vultures’
    /snip
    “These guys are really vultures. What drives this company’s moral compass?” he told NBC News in a phone interview.

  31. Intaglio says

    Forgot to mention that my comment was originally posted on Wonkette.

    One other point, IIRC EpiPen development funded by a grant from the US Department of Defense (1970’s?) because it was originally for military use. Epinephrine (adrenaline) was long known as effective so the only research and development required was for the mechanics of the auto-injector. In other words the excuse that the company needs to cover research and development costs is, as usual garbage.

  32. Nerd of Redhead, Dances OM Trolls says

    For entry into the market, the generic manufacturer has to show the ability to formulate a stable solution for injection, and show stability data for the solution, including entantiomeric stability. That’s straight forward and easy, found in the USP.

    Then it has to make a device that doesn’t infringe upon other patents, that will store the solution without degradation until its expiration date, inject the desired amount (within reasonable error) in a time of stress, and that has the same bioactivity as the EpiPen. The latter could be done with a small clinical study.

    Then it needs a sterile filling facility with proper validation studies showing that the facility is sterile, that there is no contamination during filling so the solution is pure and sterile, and that the injector will remain sterile until used. That requires at least several inches of paperwork to be reviewed by the FDA.

    While not all that complicated, it isn’t trivial either. The sterile fill operation can be killer. I heard of one company that had to abandon a facility as they could never get the testing to come up sterile, after spending many millions of dollars.

  33. dangermouse says

    My brother-in-law has to carry an epipen due to nut allergies. Here in Australia they are covered by the Pharmaceutical Benefits Scheme, so a prescription for a 2 pack costs $37, or $5.20 if you are on welfare.

  34. anbheal says

    OK, a naive suggestion, but both Mylan and Shkreli bought out other companies, or rights to certain drugs from them — companies who had already made the investment in R&D, and the various phases of clinical trials. So wouldn’t Libertarians approve of a law that says if you buy out the rights to a drug, its patent protectin expires? That’s as much of a free market principle as letting them charge as much as they can gauge from people who would die without the drug, isn’t it? Tell them here’s the deal: If you want to jack up the price, we remove the Big Gummint protection, and then let’s see where the free market price falls to, once you face actual free market competition.

    I know, I know, Libertarianism is about profits for rich white people, not actual consistent principles. But still, the problem with both of these cases is when heartless wheeler dealers buy up a life-saving drug and then extort its users. Let’s make the face competition after the point of sale, and see what tune they whistle then.

  35. Nerd of Redhead, Dances OM Trolls says

    So wouldn’t Libertarians approve of a law that says if you buy out the rights to a drug, its patent protectin expires?

    What? Their property, including the valuable patent, is no longer theirs by gvmnt fiat? *snicker*
    DOA argument.
    The patent expired on the initial EpiPen in 2008, and that was a device/formulation patent for the delivery system, not the drug substance (drug substance, the active ingredient, drug product, final formulation including Pen packaging).

  36. spamamander, internet amphibian says

    All I can say at the moment is thanks, Obama.

    And mean it.

    My state took the Medicaid expansions, which has allowed me to get state insurance even though I work, because of my income level. A month’s supply of the antidepressant that keeps me alive would be over $400 a month- for the generic.

  37. ck, the Irate Lump says

    I have to wonder: Is some critical part of the company’s auto-injector coming off patent protection in the next couple years, and they figured they needed to extort as much money as possible before other companies could start copying their designs? The two cap design of the “generics” versus one cap EpiPen sounds a lot like patent avoidance rather than an intentional design decision (considering both generic versions do the same thing).

  38. numerobis says

    The patents are long gone on many of these drugs where the price is getting jacked up. However, it takes a couple years to get tooled up and approved as Nerd detailed — that and several millions, if not tens of millions. That’s a big risk to undertake.

  39. says

    @madtom1999 #35

    You’re not sure if it’s a satire? Really? Let me help; the website is called thegoodlordabove, features a page called Ask God, and other stories include “Italy Earthquake Damage Removed By Massive Wave Of Thoughts And Prayers” and “Pope Vows To Crush Rising Religions Of Star Wars and Pokemon Go”.

    So, yeah, it’s a satire. ;)

  40. WhiteHatLurker says

    I’d be inclined to agree thegoodlordabove is a satire site, except for the article on “Trump attacks god in tweetstorm” – you can’t make up stuff like that!!

  41. slithey tove (twas brillig (stevem)) says

    When only one pharmaceutical has been approved, cleared for widespread sales, why don’t rules about monopolies (trusts) come into play? It is so obvious that such a situation is the very opposite of “free market”.
    The guy that buys the company (who shall remain nameless) that has a single effective treatment for a life threatening illness, feels perfectly fine with jacking up the price astronomically and letting competition come in to bring the prices back down. Completely disregarding “cost of entry” and time required to verify effectiveness.
    Of which he is now copied by EpiPen, and also Insulin providers. Feeling perfectly fine with hiking prices to “whatever the market will bear”. With “the market” being health insurance who will then hike their premiums to cover the cost.
    Considering pharmaceuticals as “products” [scare quotes intentional] is misguided.
    The customers are not free agents that can pick and choose their choice of meds.
    Maybe aspirin and other OTC drugs fit that description but Rx drugs and such are ~ ~ a completely different category.
    I would think that even diehard Libertarians would acknowledge the difference. Once again they fail to live up to their own ideals, cherry picking to make themselves benefited.

  42. wzrd1 says

    Here’s something th that very slightly haunts my soul.
    My father died a spare hear and change ago. He died of ESRD and vascular dementia, complicated by aortic stenosis.
    There was a chance to get him into a trial for percutaneous aortic valve replacement therapy. After agonizing considerations, we decided, no the value of replacing one valve, while not preserving brain wasn’t worth it, mutually.

    On dark nights, that slightly haunts me, but the choices were so stark.
    A bit after dad died, the valve replacement was approved.
    And honestly, dad died a long time before, it took a bit longer for his body to learn that. What he was was long gone and still mourned and this actually ripped the scab off. :(

  43. Nerd of Redhead, Dances OM Trolls says

    The Pharma market is basically broken up into three fragments, namely under patent drugs, generic drugs, and orphan drugs. Regular drugs would your blockbusters and the copycats by the other companies, still under patent. The copycat drugs help to keep the competition up, and ridiculous price increases down.
    Generic drugs are those with expired composition of matter patents, with a big enough market for the generic companies to compete for a market share based on price. Which means you as a generic drug seller have an approved manufacturer for the API, and an approved formulator/drug product facility in place prior to launch. This means validation efforts all up and down the line, which costs money. Usually the first few (often just the first) generic copies available after the original patent expires get the most marketing and makes money. Later entry is hard, but can happen if a better way to make an expensive multi-step drug is found. This market is competitive, so large price increases are unlikely unless somebody exits the market.
    Orphan drugs are those with small markets. Often there is a single supplier of the drug. The drugs can be generic, but used for an indication with a small number or patients. If the indication is new, the manufacturer can get an exclusive market for a few years before generic competition is allowed. These are usually small companies. The entry cost to the market is the same as for blockbuster generic drugs, but due to the smaller market, ROI takes longer. These small companies can’t spend a hundred million dollars on advertising. So those making orphan drugs are in position to abuse the market with costly increases, which we have seen.