I purchased EpiPens a week or so before the price drop (paid over $500). My pharmacist called me because she remembered me complaining about the price. I took my receipt in and they were able to re-run my purchase and refund me $200. It's still ridiculously expensive in my opinion.
With the lower price, it cost me $310. Driving to Canada would cost more not to mention is would be around a 20 hour round trip so I would need a hotel to stay overnight.
Diabetes is even worse. My Epipen, $370 for a Generic 2 pack. Humalog and Lantus insulin, costs $700 a month. Plus $150 of test strips a month I just got a $12,000 insulin pump, now I need $500 of pump supplies, $150 test strips, and $350 insulin every month
Locally in UK we are switching away from Epipen to Emerade. Epipen costs far less in UK than in the USA, the basic price to our NHS being Epipen 0.3mg x2 @ £52.90 ≈US $70.96. However the 3-year shelf-life of Emerade makes it a more cost effective option, although initial cost is slightly higher with Emerade 0.5mg x2 @ £57.48 ≈US $77.11. Emerade adheres to the Resuscitation Council's advised adult dose of 0.5mg, rather than Epipen idiosyncratically claiming only 0.3mg being needed, and has the longer needle length that is advised for adults thus ensuring the injection is placed deep enough to ensure proper delivery. Emerade delivers the drug faster than Epipen and is simpler to use (covering trigger-cap is same end that the needle emerges) whereas Epipen with its trigger guard being opposite end from the needle has resulted in some patients injecting their thumbs (which risks compromising blood flow to the thumb) or, worse, members of the public accidentally injecting themselves rather than the collapsed patient. So for those patients who need replacement of their Epipen because of its short 1-year shelf-life, Emerade works out to be about £19.16 ≈US $25.70 per annum for the NHS. Of course this cost is borne by our NHS, and the cost to patients is only the flat rate prescription charge of £8.40 ≈US$11.27 (just under 2% of what Americans have to pay for this), assuming they are not entirely exempt (children, fully time students to age 18, those over 60, and people on certain benefits).
The daughter of a democrat senator had a bill pushed through that had requirements that schools now stock epi pens. Then she raised the price. epi pens are able to be purchased from overseas and from Canada for a fraction of the cost they sell down the street. same brand, same pen. cheaper even with shipping.
That would explain why the government not only fails to control cost, but succeeds in raising barriers to entry. I'd prefer to only fix the latter, but that's beside the point.
Martin Stringer Ah senator, not congressman there ya go. I wonder how easy it is to purchase epipens from canada as a U.S person. If you have, do share.
epinephrin injections are a matter of life and death. i rather have the government controlling that market then having people die from bad epipen alternatives. i rather have the government only fix the first.
As an insured diabetic, I had been unaware until recent articles started hitting the news how much insulin prices had also increased in recent years since I just pay a set amount. My uninsured or poorly-insured diabetic brethren are getting royally screwed monthly. It's appalling what pharmaceutical companies have been doing with regard to basic, life-saving drugs. Pricing life-savings drugs for their "value" rather than their cost long after their original patent terms have run out is immoral in my opinion. It begs the question of where the competition is in the pharmaceutical industry and just how much collusion there is in the marketplace. Seems like a lot of pharmaceutical companies get to operate near monopolies for high revenue drugs for years until a light gets shown on the abuse and then a bunch of companies make announcements about entering the market to provide "competition" that may or may not ever arrive. My impression is that once the issue dies down and attention goes elsewhere, so does a lot of the theoretical competition. The FDA seems like the definition of regulatory capture.
Over $600 for an epipen is ridiculous. They cost $37 in Australia, so around $30 in usd under the pharmaceutical benefits scheme. How sad is it that we create drugs which save lives, but people can't afford it, and go without it. Honestly, the government needs to be able to reduce such a monopoly or have something similar to the pbs, and have prices set low for common drugs which many people need.
Hah! I just read on arstechnica this: On Tuesday, New York Attorney General Eric Schneiderman announced that his office is investigating Mylan Pharmaceuticals Inc, the maker of EpiPen, for potentially using anticompetitive terms in contracts it had with many school systems. Those terms allowed schools to receive Mylan’s EpiPens for free or at discounted prices-as long as they didn’t buy any competitors' products for a year. They maybe have been doing illegal things!
So use government to punish the capitalists who abuse government. Less regulations and smaller government, will just cede all control to those companies we already know are bad. We attack this problem at the root, big business, not at the middle-man, government.
+belialpt actually, I would say the problem is money in politics. The repeal of Glass-Steagal and the addition of several other laws, including Citizens United, have legalized bribery. For a long time, America toed the line between A Capitalistic Democratic Republic and a Plutocracy. With the laws allowing legalized bribes, we officially dove into the Plutocracy end of the pool. The people and companies with the most money, get the representation of or government. Companies like Mylan are allowed to get away with this because they can afford to buy our politicians. Conversely, Martin Shkreli did the same thing Mylan did. He bought a drug that has been around since the 50's to treat Toxoplasmosis, and raised the cost over 5000%. The difference is, he hadn't bought off the government, and it felt like they gave him chances to do so, too. In the end, he had Price Gouging charges, amongst others, brought against him. But Mylan bought the right politicians, so rather than being punished too, they were rewarded with additional laws being passed in their favor. The answer isn't more or less government. The answer is to get money out of politics, hold politicians accountable to the people they are supposed to serve, and proper regulation of corrupt corporations will follow.
belialpt Actually the problem isn't government having power, it's people manipulating that power for their needs. If you effectively shrink govt out of existence, why would those bad people suddenly become good?
Glass-Steagal actually would not cover that. It really only applied to banks and had huge loopholes. Reinstating the act will not fix this problem. That's one example of why I firmly support Hillary Clinton and her plan to not reinstate it, but to have an entirely new law that purposefully takes away the loopholes and broadens the coverage. All the other plans to just reinstate Glass-Steagal will not work and are ignorant of the current issues in the market.
One of the best since the early tour de force of national healthcare systems. I really like the investigate story telling over the general fact checking episodes but appreciated them both. Thanks
I keep thinking about a generic one-shot drug delivery device. A one-use needle cartridge at the front, a spring-loaded body, and a connection point for bottles at the back. You would preload it with epinephrine (or insulin, or other drugs), set the dosage, then add a cartridge. When it needs to be used, you'd simply use it like an epipen and then refresh the needle cartridge. The issues around dose consistency and sanitation abound, though, and it'd be tough to bring to market. On the other hand, it could save some lives, and likely be built for very low cost.
The military issues atropine (for chemical warfare) in a self contained squeezable tube with a needle for emergency self administration when in potential combat areas. Why couldn't someone create and sell the same system - oh, I forgot the FDA is limited by Congress who obey their contributors and one of the senators is the father of the CEO
We already have something similar for insulin -- it comes in "pens" with screw-on disposable needles that let you dial in a precise dose and will not deliver more than you request. The problem with insulin is that it needs to be refrigerated, doses vary WIDELY between individuals, and need for insulin is rarely urgent (except in severe cases, hyperglycemia is dangerous in the long term, not the short term -- and if glucose pills aren't handy to treat hypoglycemia, juice, soda, and candy are usually nearby just about everywhere).
Fun fact. As a pharmacist in Idaho as of July of this year, I have prescriptive authority over epinephrine auto injectors. So if there is a more cost effective alternative, I can use it.
It is wholeheartedly heartbreaking that companies can continue to charge so much for necessary medications. It makes a job such as being a physician or any job in the health care field harder because all most of us want to do is take care of our patients but unfortunately, pharmaceutical companies and insurance companies continue to get in the way of fully fulfilling the care we desire to give. This also brings up the ethical issue of justice, where those who can afford it and have been provided a different life will be able to have access to expensive drugs and those who may not be as fortunate may have to live in fear constantly because they do not have the medication/healthcare that they need. I agree with the speaker in the video when he emphasizes that the poor population are most likely to go without this very necessary medication.
I’ve never watched the Healthcare Triage videos on youtube, but I am very glad that I got to watch a couple today. These videos are very educational and a good insight into the world of healthcare. The use of the topics of epipens is just one example of how our health care system in America is charging its citizens way more money than necessary to get the medicine we need to survive. There are a large number of people in this nation that need epinephrine to put their allergic reactions to an end, but if it is too expensive, how will they be able to get it? And if they cant get it then what are they going to do when they have an allergic reaction to it and don't have their epipen to give them epinephrine to open up their airway? Epinephrine is a very cheap medicine it costs less than a dollar per millimeter, and there is less than a third of that in an epipen. Because of the way that the drug needs to be administered most of the costs of the was the packaging. When the company Mylan bought the epipen the whole cost to buy one was about fifty-seven dollars. The whole supply and demand of the product resulted in the price being raised again and again, because lets face it you need it so you have to buy it. Plus you need them for everywhere you might be the you have the allergic reaction and you need new ones every year so that they are not to expire. This becomes hundreds of dollars that is being spend every year just because you might have an allergic reaction. As of May 2016 a two pack of epipens are more than six hundred dollars, that is completely outrageous. The fact that our healthcare systems and the leading companies within it, like Mylan, think that they can rack up those prices and screw the consumers over. We need those medicines, and it’s bankrupting the majority of us to the point where we can’t even buy the medicines we need to keep us alive.
Spend a few hundred thousand dollars convincing senators, congressmen, and regulators to shut down your competition and you can see a return in the tens of billions. Don't you love it when the government "helps"?
As a school bus driver in Oregon, what sucks is that the Oregon Department of Education does not support drivers directly administering EpiPens and insulin injections. What ODE supports is getting the device ready and in the patient's hand so that they may administer it.
In Poland they cost something around 50$ for a pack and for some people with special prescriptions it's even cheaper ~ 15$. And you can also find some alternatives as cheap as 10$...
According to FARE, anaphylaxis isn't just the airways swelling. It can present in other ways too. There's gastrointestinal anaphylaxis too, which really sucks in case you were wondering.
It is ethically defunct of America to charge astronomical prices for healthcare at all, but lifesaving medication? Three things should never be mined for profit: education, prisons,&healthcare.
As a European, thats just crazy! Here in Germany you pay when prescribed 9,41 € (= 10,33 US-Dollar) per Pen. Here insurance companys push for low prices of pharmacuticals etc. (We have to admit, that you have to pay about 15% of your income for insurance.)
As a healthcare major and a caring citizen, I believe that everyone should be able to afford medication. With the rising prices of Epi Pens, Mylan's motives seemed to be based on profits instead of patients. The government seemed to also be giving Mylan a reason to raise the price; for example, selling two Epi Pens in one dose. When realizing that people need more than one Epi Pen and that the pens need to be replaced yearly, the Mylan company has no need to raise their prices. There is always a demand for Epi Pens. When lower class families cannot afford necessities like life-saving drugs, their lives are put in danger. It just makes sense to me to have a healthier country by making drugs available to everyone in every financial situation.
Honestly we need more chemists like me who DONT work for major companies who own everything they create to come together to create generic solutions to destroy pharma companies. They're WORSE than any cartell or street gang.
Fortunately we don't have this issue in Canada because the price is regulated. I've heard you can by Canadian Epipens for a much reduced cost and have them shipped to you however. Don't know the specifics though.
+saturnday oh no biotin is orally ingested and an episode on it would be way more akin to vitamins (bc they too are orally ingested in hopes of improving/maintaining health) than it would be to a topical product like makeup that has no claims of improving skin quality. Also, curious, why would you not want a video on makeup specifically?
I just for a moment imagined this channel turning into "the 35 best beauty products you haven't heard of" and it scared me a little. I already kinda think that vanity is wasting more than it's share of humanity's effort.
Biotin is something naturally found in foods etc, so taking it is more of a way to fill the gaps that you miss out on in your diet rather than boost the amounts in your body and get your hair to grow etc if that makes sense? Most vitamins cannot be stored, so we excrete the excess in urine, sweat, poo, whatever. If you're already getting enough, it isn't going to do anything. If not, it probably will help just because your body needed it and you weren't providing it. So, (like all vitamins) there's no way someone could tell you if it's a waste of money or not because it depends on your own body. Same with the hairfinity crap, it's mostly biotin anyways. If it helps, great, if not, that's also great because you're eating well. You can log your meals into a website called cronometer to see how you're doing with that and all your other nutrients. It could be a protein thing, an iron thing, there are so many Reasons to have slow hair grow or breakage. If it's really bad or out of nowhere
I think the cost of medication and physician assistance is outrageous so the title of this video really caught my attention. Both my mother and I are allergic to bee stings and while mine is not as severe of an allergy as hers is, it has been recommended to us by our doctors to purchase an EpiPen and carry one around constantly. Both of us objected that though because we, at the time, did not feel as though it was a necessary precaution to take because we live in Michigan and bees are only prevalent for 3 months out of the year at best and as adults with fulltime jobs, are not outside frequently enough to be stung regularly. What was never brought to our attention though is that Epinephrine, the drug inside of the EpiPen, expires and replacement is constantly needed. My doctor also never discussed my other options with me for other Epinephrine dosing options, she simply said that it could end me up in anaphylaxis shock and I could be hospitalized if I didn’t seek treatment within a timely fashion of being stung. I thought that monopolies were illegal in America though and I thought that there was somebody out there that had a close watch on what company drove out other competitors. It sure seems as though Mylan has a tight hold on the market and is only being enabled to continue their tight hold on said market. The cost of the EpiPen started at fifty seven dollars in 1977 and has since skyrocketed to over four hundred dollars. That is crazy. Fifty seven dollars is a whole lot more affordable than four hundred plus dollars is. I think that something so many people require to not die should be affordable too. It needs to be replaced at least yearly and has the potential to save somebody from dying, those two factors alone are enough to lower the cost of Epinephrine in my opinion.
I totally agree. I had an economics class last semester in college and we went over the inflation rates, costs, etc. of the Epipen. It is absolutely ridiculous how much the pricehas risen over the years. When I had econ. last semester, the Epipe was priced six hundred dollars for a two pack of pens. I also find it ridiculous how you have to replace them so often. Allergic reactions aren't things that happen everyday, you never reallyknow when you'll need the Epipen. Some people could go all year without needing to use an Epipen, but as soon as the pen expires, that's when it's needed the most. There are about 29 million americans today without health insurance, and those with insurance can't get enough coverage to be able to replace and Epipen every year.
The cost for an EpiPen now is outrageous. It blows my mind that they would make you pay that much for something that some people need to save their life. But now a days that is what our healthcare system has come to and it seems as if drug companies are flat out just taking advantage of their customers. They know that an EpiPen is something that is NEEDED so therefore they are going to charge a bunch of money for it because they know people will still have to buy it. I have a friend who is deathly allergic to bees and needed to buy a new EpiPen that costed her $600!! I was in shock when she told me how much it was. There's no way it should cost that much and this is a serious issue that needs to be addressed more!
As a previous user of Epipens, this situation hits close to home. Mylan almost has a monopoly on this life-saving drug dispenser, which has saved my life in the past after an extreme allergic reaction to a bee string. This company is taking complete advantage of the 1-2% of the population that needs their product and, at least in the United States, there is no one defending this minority. It's also unfortunate that the combination of doctors not being well enough versed in medication alternatives and the patents that Mylan has on these dispensers limits the competition to almost non-existence. If this price hike had happened before I had needed the device, I may not have had one available and probably would have died. I am thankful that there have been some price drops in the last month, but medication prices should be regulated more by our government and companies like Mylan should not have any ties to Congress and the politicians that run it.
This is kind of akin to the whole Daraprim mess with Martin Shkreli a few years back. But, I am wondering, how many people in the States have no form of healthcare, how many kids suffer from anaphylaxis, and how large is the overlap in that Venn Diagram?
Most allergic reactions can often be treated by the use of diphenhydramine (Benadryl), but sometimes if someone is severely allergic enough to a food or insect bites, anaphylaxis can set in. This happens in about 1-2% of allergic reactions. Anaphylaxis is when the airway starts to swells and close making it near impossible to breathe. There is a simple reversal drug to anaphylaxis, it is Epinephrine. It is a hormone produced naturally in the adrenal glands. It is also a very cheap drug, it costs about one dollar for a milliliter and there is less than a third of that in a regular EpiPen. But, in order to save a person’s life, Epinephrine has to be administered quickly and in the correct dosage. Drawing the drug into a syringe and then administering it correctly requires training that many people lack, and even if you are trained if an emergency occurs your adrenaline kicks in and it seems like skill and training is sometimes thrown out the window. Thus the birth of EpiPens. They have been available since 1977. And nine year ago, EpiPen was bought by the pharmaceutical company, Mylan. They raised the prices of a single EpiPen to $57 each. It is also proven that EpiPens do not have a long shelf life and expire after about a year, causing users to have to get replacements frequently and that means more money for Mylan. Due to its degrading qualities, using an expired EpiPen is not recommended. Epinephrine always needs to be delivered in a full dose, and if its expired, you could be less than the recommended dosage. Every year, it seems that Mylan raises the prices and recently have been selling them in packs of two only and not individually. In 2012, two competitor’s versions were discontinued and in 2013 a version came out that had an auto voice that came on and gave specific instructions to the administer. This was quickly recalled due to giving improper dosages. A generic version is in the works, but isn’t set to hit the shelves until next year. More recently, in May of 2016, a 2 pack of EpiPen auto-injector cost $600. This is a 450% increase in price since 2004. An alternative still exists, it is not cheap but it is less than the EpiPen, its called the Adrenaclick. Physicians rarely prescribe this because it is often forgotten about, and since the Adrenaclick is not technically a generic version, pharmacists cannot substitute it for a prescription written for EpiPen. A prescription for an EpiPen has to be filled by one. And this is unfortunate for users because Epinephrine is not an elective medication. It doesn’t last and needs to be replaced over time and there are no other options. This is especially upsetting for the poor or people living in poverty because they cannot afford such a drug and elect to take the risk of anaphylaxis. This is just an example of the dysfunctional American healthcare system.
So, here's an interesting side of this whole debacle: I work for a home infusion pharmacy that provides IV, subcutaneous, and complicated IM treatments for patients at home (to get them out of expensive hospitals where their risk of secondary infections is often higher). New protocols require all solumedrol (methylprednisolone) IV patients to have an epipen (not an anaphylaxis kit which contains a vial of epinepherine, among other things, for the home health nurse to administer in the case of an allergic reaction) on hand for every dose. Unfortunately, most insurances won't cover an epipen in that instance, since they argue that the epinepherine vial should be sufficient and many medical insurances (what we primarily bill as opposed to pharmaceutical insurances) don't cover it at all. We used to provide the epipens to our patients free of charge since it was much more cost effective for the pharmacy to take on the solumedrol patient and bill their main drug and nursing to insurance, which almost never costs the patient anything since they've reached their out of pocket maximum from hospital stays and specialist visits before they ever reach our intake department. Now, though, having to give a patient a free epipen (pharmacy wholesale cost of over $500) far outways any reimbursement we might get for the solumedrol and nursing. We have actually had to turn patients away and send them back to the hospital for a periodic treatment (often short term every 2 weeks or so) because we can't afford to take them with a free epipen and the patient can't afford to purchase one on their own.
We are quite lucky in India. We don't really have auto injectors, but a 1ml vile of epinephrine costs only Rs13, that's roughly 17 cents. The markup is incredible in the US.
Price in France : 69,13. 65% of which is paid back to you by the gouvernment, so 24,20. Plus, if you have even bad private insurance, you'll get it for free ! (for context, I pay 14 euros a month in private health insurance, didn't pay a cent for 1 year of physio, a back operation, and medication).
Glad I live in the UK with a free on charge system and cheaper pepipens . And if it is not too rude too ask, I was also wondering if you could do a episode on British Doctors strike. If would be nice to see a US doctors perspective. All the best!
why do they make them so expensive? because they can. Because some people believe in "free market economy" in which they believe that they should have the freedom to extort sick people, because 'Murrica & freedom and such.
streglof - Any decent person would demand this be stopped, as it's the exact opposite of "Freedom and such". Besides, it's not a "free market" if said market is monopolozed, thus your statement is formally fallacious.
Mack or Mick The "government monopoly" is a result of patent law and intellectual property rights, without which innovation becomes pointless. A free market without patent law stifles innovation. Maybe patent law needs reforming.
Just looked it up. Belgium. The normal price for one EpiPen in the farmacy is 43,60 €. People who are covered by the Belgian healthcare system pay of that 6,75 € or 11,36€ depending of your income. $ 600 is insane.
I like how you gloss over the FDA blocking competition from entering the market as if it were nothing more than a footnote. Totally not biased or anything....
In the UK you can buy the two pack for like £85. It's still ridiculously over-costed but why is it so much less than the US? Worst-case, can't you order them online and get them shipped?
EpiPens are needed for several reasons, but the prices are outrageous. The fact that Mylan keeps finding ways to up the prices and make profit is crazy. For something that cost so little to make, they sure cost a lot to purchase. I've never had to use an EpiPen so I was not aware of how much they really were. As of this year, it cost about $600 to get them per pack, which is unheard of! The government encourages these policies as well, which correlates to exactly what's wrong with America's healthcare system.
4:20 "Teva had hoped to offer a generic version of the Epipen, but concerns of the FDA sent it back at least until next year." You could have summirized the whole video in this one sentence, honestly. It isn't expensive because corporations are evil, corporations are just maximizing their profits, that's what they do. The reason it's expensive is because there is no competition, because of government regulations and patents. This is the same as every other drug or device or medical care in America. Engineering is easy, any company can make an Epipen, but dealing with government isn't.
As a person with a fairly new food allergy with a stupidly severe food allergy (I got a reaction from salad once because of cross contamination), the price hike on EpiPens sucks balls. And I need to refill my prescription in a couple of months. $600 sucks, and I don't want to pay it. But I'd rather pay $600 than die.
Thankfully my anaphylactic allergies can be easily avoided (drugs and shellfish), so I no longer need an epipen. I feel bad for sufferers of unavoidable allergies.
I agree with the statements that John Green makes in this video. The exponentially increasing prices of the EpiPen violate many ethical principals such as patient autonomy, justice and the doctrines of beneficence and maleficence. Additionally, questions should be raised about Mylan allowing patients to contract with them by purchasing the EpiPen despite the fact that patient decisions may not be fully informed on account of pharmaceutical companies or regulatory agencies withholding information about alternative options to the over-priced but necessary EpiPen. Patient autonomy is the ability for patients to make their own decisions, free of coercion or external influence. Patient autonomy is compromised in this situation because information regarding alternative treatments and the true cost of the EpiPen, both the market value and production value, are being withheld yet Mylan is still engaging in contract with patients who have not made informed decisions. To that extent, patients do not believe they have a choice because the EpiPen is potentially life-saving and viewed as a necessary sacrifice. But is it necessary to sacrifice outrageous amounts of money for something when there may be another way? Not necessarily, but patients would never know otherwise because they are not being adequately informed. This brings up the concept of justice, the idea that all persons should be treated fairly and equally. There are people who have no problem paying full price to protect their lives but is it right to raise prices knowing that people will pay no matter what? Consider those people who are unable to afford the drug and cannot pay. Are they any less deserving of life-saving treatment? Absolutely not, but Mylan seems to believe so. Finally, Mylan is violating the doctrines of beneficence and maleficence. They compromise beneficence because they are not outwardly doing any good by withholding or making it difficult for at-risk patients to access the EpiPen, yet they have the ability to be doing so. By making it difficult to feasibly access the product, they are putting a greater burden, both psychological and physical, on these patients and the healthcare systems that ultimately care for them. The drug companies are acting unethically by failing to promote health despite adequate and ample means to do so. Maleficence, acting in a manner that harms a patient, is clearly seen in this case as well. Pharmaceutical companies are malicious in the way that they hold patients hostage with high prices for basic drugs necessary to sustain life. Knowingly doing so for the sake of making money is immoral and should not be the standard of care.
In summary, it is clear that Mylan is blatantly violating many ethical principles, but can these violations be extended and applied to the FDA or other agencies such as insurance companies that are allowing such egregious offenses to persist unchecked? I would say yes, Mylan is not the only unethical player in this cycle of corruption.
I have a pretty bad hazelnut allergy and I just read ingredient list religiously and keep Benadryl with me in the hopes that it maybe will slow the reaction long enough for me to get to the hospital that's 5 mins away
Thanks for these videos. According to Wikipedia, "a silicon valley engineering consultancy" did a tear down of an EpiPen and estimated cost of production at $10. So as much as we in the UK and similar countries can sit smug about our relative lack of price gouging it seems no country's system is getting these devices at less than a multi-100% profit rate from these gangsters Mylan. The US is merely in the 1000s range
I know a few people that rely on EpiPens in the summer in case of a bee sting. As more and more people started to need EpiPens they raised the price of them. Which caused some people to be unable to afford them. It costs very little to make these pens so why do you need to raise the price? Its just so the company can make more money and make a bigger profit off of them. This is very unfair to the people that rely on these pens to save their lives in emergency situations. These pens have an expatriation date and need to be replaced every year. When they first came out the price was $57 now they are over $600. The government encourages the products use but makes little to no effort to control the products cost.
My brother is allergic to all types of fish and must have an EpiPen on him at all times, which is why I clicked on this video on the first place. I can attest to the monopoly Mylan has on the market after watching my parents shell out hundreds of dollars each time he needs to replace his EpiPen. In an ethical sense, I believe the issue of beneficence should be the biggest concern. A quick definition of beneficence is that there is moral obligation to act for the benefit of others. There is no reason that the price of EpiPens has raised over 450% since 2004 other than the fact that it is easy to use and demanded by a large group of people. I feel that Mylan and/or our government has an obligation to set a price that people can actually afford. Instead, people such as my brother are spending large sums of money just to keep anaphylaxis from killing him.
i have a risk for anaphylaxis due to a latex allergy and i work in a hospital so i have to carry an epipen on me, even with insurance i still had to pay 100$
"And Mylan raised the price..." Why do we allow companies to maintain monopoly control over life-saving medicines? Some other company could manufacture the device if there weren't patent protections in place. I'm glad we have insurance to pay for the sets of EpiPens we need each year for my kid.
How would they prevent it? The company doesn't have an enforced monopoly; they're just the only company making the product. This is why healthcare should not be covered by the private sector. At least, not entirely; making a profit for pharmaceutical companies and insurance companies and the public good are not in any way aligned.
I was arguing specifically against the patent protection. I think the patent should no longer be valid. It has been enforced long enough for the original patent holders to make back their investment.
I honor Jonas Salk who refused to patent the polio vaccine because that kind of protection should 'belong to the world'. Honor has become extinct in robber baron capitalism.
The biggest reason that this is an issue is that EpiPens involve a medication that patients who have severe anaphylaxis to specific medications cannot go without due to the risk of death. Although the pharmaceutical companies have a right to make a profit, the ethical relevance of a patient's right to life-saving medications should take precedence. Unfortunately, this is not an easy fix. As the video discussed, there have been several attempts by other manufacturers to produce a similar medication. Even AdrenaClick, which some providers have since taken to prescribing, is not truly an affordable option, although more so in comparison to the ever rising prices of the EpiPen. It is likely that at some point in the future this will involve a lawsuit after a patient dies from an anaphylactic reaction after not being able to afford their medication, however ideally we should come up with a better solution prior to something this drastic occurring. It will be interesting to see how effective pre-filled syringes may be on patient outcomes in the future, although it sounds like this solution is currently farther out than we have time for. The most realistic option would be for another pharmaceutical company to come up with a more efficient generic mechanism to replace the EpiPen, and force Mylan to reconsider their outrageous prices. Additionally, it might be time for the government to step up and force some additional regulations given the serious health risk associated with inaccessibility to this medication.
Jesus, in my county you can get 2 free epipens a year and if you use one because you needed to you get a free replacement yes the alternatives exist for lower prices but there have been cases where they were used incorrectly and ended up "killing" the person with the allergy. I was also wondering what the laws are regarding using epipens in the US are here we are allowed to use an expired or another persons epipen (in a school for example) as long as there are no other options and the persons who's epipen is used is kept under close watch and kept safe until another epipen is available. Is this the same in the US?
I saved a couple hundred dollars by buying another brand (not sure what it is) but I guess it's tip doesn't withdraw after use so you have to be careful not to poke yourself after you use it. I'm not sure how my parents found out about it, but they had to drive to a different pharmacy kinda far away I think. Hopefully I'll never have to find out if it works or not.
Why don't they just allow intracardiac injections. It'd mean a lower dose and a quicker onset of action. It's not like it's hard. Just go four ribs down and your there.
In Canada, 1 epipen costs about 78 USD and the price has been stable since 2007, because it's not Mylen that distributes it, but a subsidiary of Pfizer's.
I see this as an opportunity. Surely one could develop a computer controlled disposable auto-injector that was cheaper. Would that breach the patent on the injection system?
So how is this different from insulin? Is it too much to think we can draw that and store that but we can't with this somehow? I fail to see the difference. Both require planning and changing your lifestyle dramatically.
I guess the big difference is in school. Not every teacher is going to measure things out just right when under pressure. Not every class is going to have a cooler to store the medicine correctly.
How much training do you actually need to do an emergency injection? A 5 minute training video? A day long course (Like CPR Cert Class)? More? At one of my old jobs a coworker needed an insulin injection and had gone too long without it so he was all weak and shaking and unable to really speak clearly or walk easily. His kit was back in the truck and he told me he was going to pass out before I got back with it, so just follow the directions on the box and do the injection. The directions consisted of a stick figure showing you how to draw the stuff from the little bottle and where to inject it, literally two pictures and probably 12 words. It was easy, he woke up just in time for the EMTs to reach us. I am all for the auto-injectors, I'm just curious how much training the syringe method requires. Did I get lucky and just do it right? I mean, the guy lived and was back to work the next day, so... Success?
Mylan is taking advantage of the EpiPens being (basically) the only Epinephrine on the market. Physicians write prescriptions for their patients no matter how rich/poor they are. Poor patients cannot afford to buy EpiPens every year. $600 for 2 EpiPens seem way over priced in our current market. I believe that if Mylan can keep increasing the price of EpiPens, then the patient's insurance should cover more than half of the bill. An EpiPen can save someone's life and no one should have to pay over $100 for it.
This points out the effects of any government created monopoly, which are especially evident in the US healthcare system. Any monopoly in any field is going to raise its price to where its profits are maximized. And the FDA routinely grants monopolies. In most other countries, the government will set the price. Of course, they can do that, because in most cases the US has already foot the bill for development costs, and the other countries only pay for the marginal cost of production. In effect, the US is paying for the world's drug development. Solutions to this problem are easy to figure out, ranging from government price controls on monopoly drugs, to limiting the length of the monopoly. But this is a very arcane issue, and I know of no group or association advocating for it. OTOH, drug companies are very well aware of the issue, and lobby Congress incessantly.
wouldn't you think that huge deregulation by the government would also solve the problem? in any industry with little regulation, the free market system lowers price and increases quality.
Of course, when Congress passes legislation mandating an emergency stash of something supplied by only a few firms, we should not be surprised that the market suddenly tolerates a higher price for the higher demanded quantity.
Why is there not a generic version of the EpiPen? The original patent should be expired by now and the drug is cheap and outside of patent so no one else wants to make a generic at half this exorbitant price?
Indonesia have a price at about 52 bucks non prescription. Which is still very expensive in this country's standard but still not a kidney's worth like whatever the US got. If a considered developing country have it way cheaper than you, you know something's wrong
Regulatory Capture. Strict Prescription Rules. Patent Protection. Regulations and Time to Market. Insurance masking the message of price. Legislating preference of a product. Legislation reducing options on insurance. Yep, those are the problems with medical devices in general and the rest of the US healthcare system... Government Involvement... NOT CORPORATIONS.
The fact that companies can raise their prices with no rhyme or reason is one of the BIGGEST problems in healthcare today. When and where does it stop. I understand medications that are harder to come by, have a lesser need for, or even that aren't used often having a higher cost. But the epi-pen? Shame on Mylan as well as our government for allowing this to happen. I know this is not the only medicine this has happened to also. There are so many people out there that need the epi-pen. And it's not like people choose to have life threatening allergies that make them need this medication. I am curious, how much, if any does an insurance company cover? But that still does not make it right when not everyone even has health insurance. The government needs to take control of this situation because we know Mylan is not the first and will not be the last to take advantage of the need for their medication. No one on this planet should have to go without an epi-pen if they need it. In most cases and forms birth control is free, so why can't epi-pens? Personally, I value the need of an epi-pen more than I do birth control. Epi-pens should be accessible at a low cost, to all people who have a written prescription for them. Especially since they noted that the cost of epinephrine is very low. It should be downright illegal for things like this to happen in our modern day healthcare system.
This is legally a case of breaking anti-trust laws, but ethically it is one of conflict of interest, one that can be traced right to the top of Mylan. The CEO of Mylan during this drastic rise in the price of EpiPen has been Heather Bresch and according to NBC news from 2007 to 2015 during the time that the EpiPen retail cost rose 461%, while her salary increased by 671%. On the surface this seems a clear case of a monopoly, and possibly price gouging, but it is much more complex and possibly calculated. Heather Bresch just so happens to be the daughter of Sen. Joe Manchin, whom in 2007 was the Governor of West Virginia. Joe Manchin’s wife is Gayle Manchin. Gayle is on the West Virginia State Board of Education, which is an appointed position. Gayle was appointed to that position by her husband, the then Governor of West Virginia for a nine year term in 2007. While on the board, Gayle used her position to lobby for Mylan’s "EpiPen4Schools” program which gave away EpiPens to schools and promoted the idea that schools need to purchase EpiPens. These campaigns then lead to “Eleven states drafted laws requiring epinephrine auto-injectors. Nearly every other state recommended schools stock them after what the White House called the ‘EpiPen Law’ in 2013 gave funding preference to those that did,” according to USA today. www.usatoday.com/story/news/politics/2016/09/20/family-matters-epipens-had-help-getting-schools-manchin-bresch/90435218/ But what are pharmaceutical corporations’ ethical obligations? Is it to the patients that the medications are being sold to? Is it to the taxpayers, or is it to the corporate stockholders? Because pharmaceuticals are a part of the medical system of care I believe that they should be held to the same ethical standards as doctor and nurses, and not those of profiteering corporations. Aaron Carroll points out that the recoupment for the cost of research and development (R&D) for this particular drug has long been met, and the profit margin well exceeds the norm, but that is not the problem. It is apparent the profits from this price hike wasn’t reinvested in further R&D, it was pocketed by this CEO. The problem is that Mylan’s CEO used the influence of her parents political positions for personal monetary gain on the taxpayers’ dime and at the expense of patients who need this lifesaving drug. This is a clear conflict of interest, in my opinion.
I purchased EpiPens a week or so before the price drop (paid over $500). My pharmacist called me because she remembered me complaining about the price. I took my receipt in and they were able to re-run my purchase and refund me $200. It's still ridiculously expensive in my opinion.
That's great service, nice pharmacist!
I want to send your pharmacist cookies!
I was walking out of the pharmacy today and this same pharmacist was on a poster for winning a corporate wide service award. Good for her!
Cost of passport (120$) cost of gaz to drive to Canada (100 to 200)$ Price of Epipens in Canada (99$)... Total price less than 500$...
With the lower price, it cost me $310. Driving to Canada would cost more not to mention is would be around a 20 hour round trip so I would need a hotel to stay overnight.
Since the mylan CEOs father is a senator, I wonder if anyone could believe he might have had a role in the FDA rejection of alternatives.
Joe Manchin and his daughter Heather Bresch. There are questions about her lying to congress about the price gouging of the epipen.
Diabetes is even worse. My Epipen, $370 for a Generic 2 pack. Humalog and Lantus insulin, costs $700 a month. Plus $150 of test strips a month
I just got a $12,000 insulin pump, now I need $500 of pump supplies, $150 test strips, and $350 insulin every month
Move to *Canada*
Locally in UK we are switching away from Epipen to Emerade. Epipen costs far less in UK than in the USA, the basic price to our NHS being Epipen 0.3mg x2 @ £52.90 ≈US $70.96. However the 3-year shelf-life of Emerade makes it a more cost effective option, although initial cost is slightly higher with Emerade 0.5mg x2 @ £57.48 ≈US $77.11. Emerade adheres to the Resuscitation Council's advised adult dose of 0.5mg, rather than Epipen idiosyncratically claiming only 0.3mg being needed, and has the longer needle length that is advised for adults thus ensuring the injection is placed deep enough to ensure proper delivery. Emerade delivers the drug faster than Epipen and is simpler to use (covering trigger-cap is same end that the needle emerges) whereas Epipen with its trigger guard being opposite end from the needle has resulted in some patients injecting their thumbs (which risks compromising blood flow to the thumb) or, worse, members of the public accidentally injecting themselves rather than the collapsed patient. So for those patients who need replacement of their Epipen because of its short 1-year shelf-life, Emerade works out to be about £19.16 ≈US $25.70 per annum for the NHS. Of course this cost is borne by our NHS, and the cost to patients is only the flat rate prescription charge of £8.40 ≈US$11.27 (just under 2% of what Americans have to pay for this), assuming they are not entirely exempt (children, fully time students to age 18, those over 60, and people on certain benefits).
Drink every time he says "Mylan raised the price again."
Drink every time Mylan raises the price again.
Thanks for doing this. I've been watching for about two years now. This is one of my favorite series to watch. Please keep it up!
What they neglected to mention was the connection to mylan and congress.......
The daughter of a democrat senator had a bill pushed through that had requirements that schools now stock epi pens. Then she raised the price.
epi pens are able to be purchased from overseas and from Canada for a fraction of the cost they sell down the street. same brand, same pen. cheaper even with shipping.
That would explain why the government not only fails to control cost, but succeeds in raising barriers to entry. I'd prefer to only fix the latter, but that's beside the point.
Martin Stringer
Ah senator, not congressman there ya go.
I wonder how easy it is to purchase epipens from canada as a U.S person. If you have, do share.
Senators are congressmen, congress is made of the Senate and the House of representatives in the USA.
epinephrin injections are a matter of life and death. i rather have the government controlling that market then having people die from bad epipen alternatives. i rather have the government only fix the first.
As an insured diabetic, I had been unaware until recent articles started hitting the news how much insulin prices had also increased in recent years since I just pay a set amount. My uninsured or poorly-insured diabetic brethren are getting royally screwed monthly.
It's appalling what pharmaceutical companies have been doing with regard to basic, life-saving drugs. Pricing life-savings drugs for their "value" rather than their cost long after their original patent terms have run out is immoral in my opinion. It begs the question of where the competition is in the pharmaceutical industry and just how much collusion there is in the marketplace. Seems like a lot of pharmaceutical companies get to operate near monopolies for high revenue drugs for years until a light gets shown on the abuse and then a bunch of companies make announcements about entering the market to provide "competition" that may or may not ever arrive. My impression is that once the issue dies down and attention goes elsewhere, so does a lot of the theoretical competition.
The FDA seems like the definition of regulatory capture.
Over $600 for an epipen is ridiculous. They cost $37 in Australia, so around $30 in usd under the pharmaceutical benefits scheme. How sad is it that we create drugs which save lives, but people can't afford it, and go without it. Honestly, the government needs to be able to reduce such a monopoly or have something similar to the pbs, and have prices set low for common drugs which many people need.
This is a good example of why I take issue with arguments about "what the market can bear."
Hah! I just read on arstechnica this:
On Tuesday, New York Attorney General Eric Schneiderman announced that his office is investigating Mylan Pharmaceuticals Inc, the maker of EpiPen, for potentially using anticompetitive terms in contracts it had with many school systems. Those terms allowed schools to receive Mylan’s EpiPens for free or at discounted prices-as long as they didn’t buy any competitors' products for a year.
They maybe have been doing illegal things!
MAY????
New York lawyers be like "Yeeeeesss, about to do what we do best!"
Incredibly well-organized and informative episode.
This is a clear problem with regulation and government being bought to keep the monopoly.
So use government to punish the capitalists who abuse government. Less regulations and smaller government, will just cede all control to those companies we already know are bad. We attack this problem at the root, big business, not at the middle-man, government.
+belialpt actually, I would say the problem is money in politics. The repeal of Glass-Steagal and the addition of several other laws, including Citizens United, have legalized bribery. For a long time, America toed the line between A Capitalistic Democratic Republic and a Plutocracy. With the laws allowing legalized bribes, we officially dove into the Plutocracy end of the pool. The people and companies with the most money, get the representation of or government. Companies like Mylan are allowed to get away with this because they can afford to buy our politicians. Conversely, Martin Shkreli did the same thing Mylan did. He bought a drug that has been around since the 50's to treat Toxoplasmosis, and raised the cost over 5000%. The difference is, he hadn't bought off the government, and it felt like they gave him chances to do so, too. In the end, he had Price Gouging charges, amongst others, brought against him. But Mylan bought the right politicians, so rather than being punished too, they were rewarded with additional laws being passed in their favor.
The answer isn't more or less government. The answer is to get money out of politics, hold politicians accountable to the people they are supposed to serve, and proper regulation of corrupt corporations will follow.
I'm going to follow this threat for potential debates.
belialpt Actually the problem isn't government having power, it's people manipulating that power for their needs. If you effectively shrink govt out of existence, why would those bad people suddenly become good?
Glass-Steagal actually would not cover that. It really only applied to banks and had huge loopholes. Reinstating the act will not fix this problem. That's one example of why I firmly support Hillary Clinton and her plan to not reinstate it, but to have an entirely new law that purposefully takes away the loopholes and broadens the coverage. All the other plans to just reinstate Glass-Steagal will not work and are ignorant of the current issues in the market.
One of the best since the early tour de force of national healthcare systems. I really like the investigate story telling over the general fact checking episodes but appreciated them both. Thanks
Meanwhile, EpiPens cost £85 in the UK or $130. That's not to be sneezed at, but that sure as hell is a more reasonable price
And about 40 in Australia
is that for a 2 pack or for a single pen?
twin pack in uk is £89
www.europapharmacy.co.uk/epipen
Is that what the NHS pays for them, or what it costs to acquire it privately?
Ralphie Raccoon
what it costs to get it privately with an NHS prescription, I'm guessing the NHS pays more
I keep thinking about a generic one-shot drug delivery device. A one-use needle cartridge at the front, a spring-loaded body, and a connection point for bottles at the back. You would preload it with epinephrine (or insulin, or other drugs), set the dosage, then add a cartridge. When it needs to be used, you'd simply use it like an epipen and then refresh the needle cartridge.
The issues around dose consistency and sanitation abound, though, and it'd be tough to bring to market. On the other hand, it could save some lives, and likely be built for very low cost.
The military issues atropine (for chemical warfare) in a self contained squeezable tube with a needle for emergency self administration when in potential combat areas. Why couldn't someone create and sell the same system - oh, I forgot the FDA is limited by Congress who obey their contributors and one of the senators is the father of the CEO
We already have something similar for insulin -- it comes in "pens" with screw-on disposable needles that let you dial in a precise dose and will not deliver more than you request. The problem with insulin is that it needs to be refrigerated, doses vary WIDELY between individuals, and need for insulin is rarely urgent (except in severe cases, hyperglycemia is dangerous in the long term, not the short term -- and if glucose pills aren't handy to treat hypoglycemia, juice, soda, and candy are usually nearby just about everywhere).
Fun fact. As a pharmacist in Idaho as of July of this year, I have prescriptive authority over epinephrine auto injectors. So if there is a more cost effective alternative, I can use it.
Too bad not all 50 states & U.S. territories allow the same prescriptive authority for pharmacists.
It is wholeheartedly heartbreaking that companies can continue to charge so much for necessary medications. It makes a job such as being a physician or any job in the health care field harder because all most of us want to do is take care of our patients but unfortunately, pharmaceutical companies and insurance companies continue to get in the way of fully fulfilling the care we desire to give. This also brings up the ethical issue of justice, where those who can afford it and have been provided a different life will be able to have access to expensive drugs and those who may not be as fortunate may have to live in fear constantly because they do not have the medication/healthcare that they need. I agree with the speaker in the video when he emphasizes that the poor population are most likely to go without this very necessary medication.
Apparently I picked a good time to need this medicine. I just paid $22 after insurance. Pharmacist said that it was $100 without insurance!
I could tell that Aaron was reeeeaaaally pissed about this. Good for him!
I’ve never watched the Healthcare Triage videos on youtube, but I am very glad that I got to watch a couple today. These videos are very educational and a good insight into the world of healthcare. The use of the topics of epipens is just one example of how our health care system in America is charging its citizens way more money than necessary to get the medicine we need to survive. There are a large number of people in this nation that need epinephrine to put their allergic reactions to an end, but if it is too expensive, how will they be able to get it? And if they cant get it then what are they going to do when they have an allergic reaction to it and don't have their epipen to give them epinephrine to open up their airway?
Epinephrine is a very cheap medicine it costs less than a dollar per millimeter, and there is less than a third of that in an epipen. Because of the way that the drug needs to be administered most of the costs of the was the packaging. When the company Mylan bought the epipen the whole cost to buy one was about fifty-seven dollars. The whole supply and demand of the product resulted in the price being raised again and again, because lets face it you need it so you have to buy it. Plus you need them for everywhere you might be the you have the allergic reaction and you need new ones every year so that they are not to expire. This becomes hundreds of dollars that is being spend every year just because you might have an allergic reaction. As of May 2016 a two pack of epipens are more than six hundred dollars, that is completely outrageous. The fact that our healthcare systems and the leading companies within it, like Mylan, think that they can rack up those prices and screw the consumers over. We need those medicines, and it’s bankrupting the majority of us to the point where we can’t even buy the medicines we need to keep us alive.
$600 a pack? Are you fucking kidding me? They're sold for £28 a pack to the NHS
Spend a few hundred thousand dollars convincing senators, congressmen, and regulators to shut down your competition and you can see a return in the tens of billions.
Don't you love it when the government "helps"?
As a school bus driver in Oregon, what sucks is that the Oregon Department of Education does not support drivers directly administering EpiPens and insulin injections. What ODE supports is getting the device ready and in the patient's hand so that they may administer it.
My question is: Which Politicians/FDA bureacrats are Myelin's lobbyists paying off to maintain their monopoly and for how much.
Joe Manchin
In Poland they cost something around 50$ for a pack and for some people with special prescriptions it's even cheaper ~ 15$. And you can also find some alternatives as cheap as 10$...
According to FARE, anaphylaxis isn't just the airways swelling. It can present in other ways too. There's gastrointestinal anaphylaxis too, which really sucks in case you were wondering.
It is ethically defunct of America to charge astronomical prices for healthcare at all, but lifesaving medication? Three things should never be mined for profit: education, prisons,&healthcare.
The fact that it's even legal for Mylan to raise their prices virtually indiscriminately is one of the biggest problems with our healthcare system..
As a European, thats just crazy!
Here in Germany you pay when prescribed 9,41 € (= 10,33 US-Dollar) per Pen.
Here insurance companys push for low prices of pharmacuticals etc.
(We have to admit, that you have to pay about 15% of your income for insurance.)
As a healthcare major and a caring citizen, I believe that everyone should be able to afford medication. With the rising prices of Epi Pens, Mylan's motives seemed to be based on profits instead of patients. The government seemed to also be giving Mylan a reason to raise the price; for example, selling two Epi Pens in one dose. When realizing that people need more than one Epi Pen and that the pens need to be replaced yearly, the Mylan company has no need to raise their prices. There is always a demand for Epi Pens. When lower class families cannot afford necessities like life-saving drugs, their lives are put in danger. It just makes sense to me to have a healthier country by making drugs available to everyone in every financial situation.
Honestly we need more chemists like me who DONT work for major companies who own everything they create to come together to create generic solutions to destroy pharma companies. They're WORSE than any cartell or street gang.
Fortunately we don't have this issue in Canada because the price is regulated. I've heard you can by Canadian Epipens for a much reduced cost and have them shipped to you however. Don't know the specifics though.
Could you do an episode on biotin and like drugs that claim to increase hair/growth. I'd like to know if it's a waste of money or not.
I actually hope this channel steers clear of cosmetics.
+saturnday oh no biotin is orally ingested and an episode on it would be way more akin to vitamins (bc they too are orally ingested in hopes of improving/maintaining health) than it would be to a topical product like makeup that has no claims of improving skin quality. Also, curious, why would you not want a video on makeup specifically?
I just for a moment imagined this channel turning into "the 35 best beauty products you haven't heard of" and it scared me a little. I already kinda think that vanity is wasting more than it's share of humanity's effort.
Biotin is something naturally found in foods etc, so taking it is more of a way to fill the gaps that you miss out on in your diet rather than boost the amounts in your body and get your hair to grow etc if that makes sense? Most vitamins cannot be stored, so we excrete the excess in urine, sweat, poo, whatever. If you're already getting enough, it isn't going to do anything. If not, it probably will help just because your body needed it and you weren't providing it. So, (like all vitamins) there's no way someone could tell you if it's a waste of money or not because it depends on your own body. Same with the hairfinity crap, it's mostly biotin anyways. If it helps, great, if not, that's also great because you're eating well. You can log your meals into a website called cronometer to see how you're doing with that and all your other nutrients. It could be a protein thing, an iron thing, there are so many Reasons to have slow hair grow or breakage. If it's really bad or out of nowhere
You gotta ask your doctor
I think the cost of medication and physician assistance is outrageous so the title of this video really caught my attention. Both my mother and I are allergic to bee stings and while mine is not as severe of an allergy as hers is, it has been recommended to us by our doctors to purchase an EpiPen and carry one around constantly. Both of us objected that though because we, at the time, did not feel as though it was a necessary precaution to take because we live in Michigan and bees are only prevalent for 3 months out of the year at best and as adults with fulltime jobs, are not outside frequently enough to be stung regularly. What was never brought to our attention though is that Epinephrine, the drug inside of the EpiPen, expires and replacement is constantly needed. My doctor also never discussed my other options with me for other Epinephrine dosing options, she simply said that it could end me up in anaphylaxis shock and I could be hospitalized if I didn’t seek treatment within a timely fashion of being stung.
I thought that monopolies were illegal in America though and I thought that there was somebody out there that had a close watch on what company drove out other competitors. It sure seems as though Mylan has a tight hold on the market and is only being enabled to continue their tight hold on said market. The cost of the EpiPen started at fifty seven dollars in 1977 and has since skyrocketed to over four hundred dollars. That is crazy. Fifty seven dollars is a whole lot more affordable than four hundred plus dollars is. I think that something so many people require to not die should be affordable too. It needs to be replaced at least yearly and has the potential to save somebody from dying, those two factors alone are enough to lower the cost of Epinephrine in my opinion.
I totally agree. I had an economics class last semester in college and we went over the inflation rates, costs, etc. of the Epipen. It is absolutely ridiculous how much the pricehas risen over the years. When I had econ. last semester, the Epipe was priced six hundred dollars for a two pack of pens. I also find it ridiculous how you have to replace them so often. Allergic reactions aren't things that happen everyday, you never reallyknow when you'll need the Epipen. Some people could go all year without needing to use an Epipen, but as soon as the pen expires, that's when it's needed the most. There are about 29 million americans today without health insurance, and those with insurance can't get enough coverage to be able to replace and Epipen every year.
The Epipen made in France by Mylan is the same of the American Epipen?
The cost for an EpiPen now is outrageous. It blows my mind that they would make you pay that much for something that some people need to save their life. But now a days that is what our healthcare system has come to and it seems as if drug companies are flat out just taking advantage of their customers. They know that an EpiPen is something that is NEEDED so therefore they are going to charge a bunch of money for it because they know people will still have to buy it. I have a friend who is deathly allergic to bees and needed to buy a new EpiPen that costed her $600!! I was in shock when she told me how much it was. There's no way it should cost that much and this is a serious issue that needs to be addressed more!
As a previous user of Epipens, this situation hits close to home. Mylan almost has a monopoly on this life-saving drug dispenser, which has saved my life in the past after an extreme allergic reaction to a bee string. This company is taking complete advantage of the 1-2% of the population that needs their product and, at least in the United States, there is no one defending this minority. It's also unfortunate that the combination of doctors not being well enough versed in medication alternatives and the patents that Mylan has on these dispensers limits the competition to almost non-existence. If this price hike had happened before I had needed the device, I may not have had one available and probably would have died. I am thankful that there have been some price drops in the last month, but medication prices should be regulated more by our government and companies like Mylan should not have any ties to Congress and the politicians that run it.
What is it about epinephrine that makes in unable to be substituted for another drug?
I used to carry an Epipen, not because I needed it, but because someone else might. Sadly I can no longer do that.
This is kind of akin to the whole Daraprim mess with Martin Shkreli a few years back. But, I am wondering, how many people in the States have no form of healthcare, how many kids suffer from anaphylaxis, and how large is the overlap in that Venn Diagram?
Most allergic reactions can often be treated by the use of diphenhydramine (Benadryl), but sometimes if someone is severely allergic enough to a food or insect bites, anaphylaxis can set in. This happens in about 1-2% of allergic reactions. Anaphylaxis is when the airway starts to swells and close making it near impossible to breathe. There is a simple reversal drug to anaphylaxis, it is Epinephrine. It is a hormone produced naturally in the adrenal glands. It is also a very cheap drug, it costs about one dollar for a milliliter and there is less than a third of that in a regular EpiPen. But, in order to save a person’s life, Epinephrine has to be administered quickly and in the correct dosage. Drawing the drug into a syringe and then administering it correctly requires training that many people lack, and even if you are trained if an emergency occurs your adrenaline kicks in and it seems like skill and training is sometimes thrown out the window. Thus the birth of EpiPens. They have been available since 1977. And nine year ago, EpiPen was bought by the pharmaceutical company, Mylan. They raised the prices of a single EpiPen to $57 each. It is also proven that EpiPens do not have a long shelf life and expire after about a year, causing users to have to get replacements frequently and that means more money for Mylan. Due to its degrading qualities, using an expired EpiPen is not recommended. Epinephrine always needs to be delivered in a full dose, and if its expired, you could be less than the recommended dosage. Every year, it seems that Mylan raises the prices and recently have been selling them in packs of two only and not individually. In 2012, two competitor’s versions were discontinued and in 2013 a version came out that had an auto voice that came on and gave specific instructions to the administer. This was quickly recalled due to giving improper dosages. A generic version is in the works, but isn’t set to hit the shelves until next year.
More recently, in May of 2016, a 2 pack of EpiPen auto-injector cost $600. This is a 450% increase in price since 2004. An alternative still exists, it is not cheap but it is less than the EpiPen, its called the Adrenaclick. Physicians rarely prescribe this because it is often forgotten about, and since the Adrenaclick is not technically a generic version, pharmacists cannot substitute it for a prescription written for EpiPen. A prescription for an EpiPen has to be filled by one. And this is unfortunate for users because Epinephrine is not an elective medication. It doesn’t last and needs to be replaced over time and there are no other options. This is especially upsetting for the poor or people living in poverty because they cannot afford such a drug and elect to take the risk of anaphylaxis. This is just an example of the dysfunctional American healthcare system.
So, here's an interesting side of this whole debacle: I work for a home infusion pharmacy that provides IV, subcutaneous, and complicated IM treatments for patients at home (to get them out of expensive hospitals where their risk of secondary infections is often higher). New protocols require all solumedrol (methylprednisolone) IV patients to have an epipen (not an anaphylaxis kit which contains a vial of epinepherine, among other things, for the home health nurse to administer in the case of an allergic reaction) on hand for every dose.
Unfortunately, most insurances won't cover an epipen in that instance, since they argue that the epinepherine vial should be sufficient and many medical insurances (what we primarily bill as opposed to pharmaceutical insurances) don't cover it at all. We used to provide the epipens to our patients free of charge since it was much more cost effective for the pharmacy to take on the solumedrol patient and bill their main drug and nursing to insurance, which almost never costs the patient anything since they've reached their out of pocket maximum from hospital stays and specialist visits before they ever reach our intake department.
Now, though, having to give a patient a free epipen (pharmacy wholesale cost of over $500) far outways any reimbursement we might get for the solumedrol and nursing. We have actually had to turn patients away and send them back to the hospital for a periodic treatment (often short term every 2 weeks or so) because we can't afford to take them with a free epipen and the patient can't afford to purchase one on their own.
We are quite lucky in India. We don't really have auto injectors, but a 1ml vile of epinephrine costs only Rs13, that's roughly 17 cents. The markup is incredible in the US.
There is a generic for mylans Epipen, at least my pharmacist gave one to me. AuviQ is also back I believe.
I remember in 2009 I could get epipens for like $60 a pen. I’m deadly allergic to peanuts and having to pay $500+ a year for two epipens is ridiculous
Price in France : 69,13. 65% of which is paid back to you by the gouvernment, so 24,20. Plus, if you have even bad private insurance, you'll get it for free ! (for context, I pay 14 euros a month in private health insurance, didn't pay a cent for 1 year of physio, a back operation, and medication).
This pen is a lifesaver and it needs to be fairly available
Glad I live in the UK with a free on charge system and cheaper pepipens . And if it is not too rude too ask, I was also wondering if you could do a episode on British Doctors strike. If would be nice to see a US doctors perspective. All the best!
Schools with nurses should be fine with the epinephrine/syringe combination. It's what we use on ALS ambulances.
why do they make them so expensive? because they can. Because some people believe in "free market economy" in which they believe that they should have the freedom to extort sick people, because 'Murrica & freedom and such.
Exactly how do you define a government enforced monopoly on the production of EpiPens as a "free market?"
streglof - Any decent person would demand this be stopped, as it's the exact opposite of "Freedom and such". Besides, it's not a "free market" if said market is monopolozed, thus your statement is formally fallacious.
you already can buy them from china for peanuts
but do you really trust china not to fuck it up and potentially kill you?
Mack or Mick The "government monopoly" is a result of patent law and intellectual property rights, without which innovation becomes pointless. A free market without patent law stifles innovation. Maybe patent law needs reforming.
Just looked it up. Belgium. The normal price for one EpiPen in the farmacy is 43,60 €. People who are covered by the Belgian healthcare system pay of that 6,75 € or 11,36€ depending of your income. $ 600 is insane.
Which is equivalent to $51.38
I like how you gloss over the FDA blocking competition from entering the market as if it were nothing more than a footnote. Totally not biased or anything....
In the UK you can buy the two pack for like £85. It's still ridiculously over-costed but why is it so much less than the US? Worst-case, can't you order them online and get them shipped?
Is it really that difficult for a company to develop a competing product?
EpiPens are needed for several reasons, but the prices are outrageous. The fact that Mylan keeps finding ways to up the prices and make profit is crazy. For something that cost so little to make, they sure cost a lot to purchase. I've never had to use an EpiPen so I was not aware of how much they really were. As of this year, it cost about $600 to get them per pack, which is unheard of! The government encourages these policies as well, which correlates to exactly what's wrong with America's healthcare system.
4:20 "Teva had hoped to offer a generic version of the Epipen, but concerns of the FDA sent it back at least until next year."
You could have summirized the whole video in this one sentence, honestly. It isn't expensive because corporations are evil, corporations are just maximizing their profits, that's what they do. The reason it's expensive is because there is no competition, because of government regulations and patents. This is the same as every other drug or device or medical care in America. Engineering is easy, any company can make an Epipen, but dealing with government isn't.
As a person with a fairly new food allergy with a stupidly severe food allergy (I got a reaction from salad once because of cross contamination), the price hike on EpiPens sucks balls. And I need to refill my prescription in a couple of months. $600 sucks, and I don't want to pay it. But I'd rather pay $600 than die.
Thankfully my anaphylactic allergies can be easily avoided (drugs and shellfish), so I no longer need an epipen. I feel bad for sufferers of unavoidable allergies.
I agree with the statements that John Green makes in this video. The exponentially increasing prices of the EpiPen violate many ethical principals such as patient autonomy, justice and the doctrines of beneficence and maleficence. Additionally, questions should be raised about Mylan allowing patients to contract with them by purchasing the EpiPen despite the fact that patient decisions may not be fully informed on account of pharmaceutical companies or regulatory agencies withholding information about alternative options to the over-priced but necessary EpiPen.
Patient autonomy is the ability for patients to make their own decisions, free of coercion or external influence.
Patient autonomy is compromised in this situation because information regarding alternative treatments and the true cost of the EpiPen, both the market value and production value, are being withheld yet Mylan is still engaging in contract with patients who have not made informed decisions. To that extent, patients do not believe they have a choice because the EpiPen is potentially life-saving and viewed as a necessary sacrifice. But is it necessary to sacrifice outrageous amounts of money for something when there may be another way? Not necessarily, but patients would never know otherwise because they are not being adequately informed. This brings up the concept of justice, the idea that all persons should be treated fairly and equally. There are people who have no problem paying full price to protect their lives but is it right to raise prices knowing that people will pay no matter what? Consider those people who are unable to afford the drug and cannot pay. Are they any less deserving of life-saving treatment? Absolutely not, but Mylan seems to believe so.
Finally, Mylan is violating the doctrines of beneficence and maleficence. They compromise beneficence because they are not outwardly doing any good by withholding or making it difficult for at-risk patients to access the EpiPen, yet they have the ability to be doing so. By making it difficult to feasibly access the product, they are putting a greater burden, both psychological and physical, on these patients and the healthcare systems that ultimately care for them. The drug companies are acting unethically by failing to promote health despite adequate and ample means to do so. Maleficence, acting in a manner that harms a patient, is clearly seen in this case as well. Pharmaceutical companies are malicious in the way that they hold patients hostage with high prices for basic drugs necessary to sustain life. Knowingly doing so for the sake of making money is immoral and should not be the standard of care.
In summary, it is clear that Mylan is blatantly violating many ethical principles, but can these violations be extended and applied to the FDA or other agencies such as insurance companies that are allowing such egregious offenses to persist unchecked? I would say yes, Mylan is not the only unethical player in this cycle of corruption.
I have a pretty bad hazelnut allergy and I just read ingredient list religiously and keep Benadryl with me in the hopes that it maybe will slow the reaction long enough for me to get to the hospital that's 5 mins away
So when can there be a generic one?
Thanks for these videos.
According to Wikipedia, "a silicon valley engineering consultancy" did a tear down of an EpiPen and estimated cost of production at $10. So as much as we in the UK and similar countries can sit smug about our relative lack of price gouging it seems no country's system is getting these devices at less than a multi-100% profit rate from these gangsters Mylan. The US is merely in the 1000s range
And I thought selling drugs on the street got people rich, who knew doing it the legal way would get you way richer.
thanks man
your videos helped me study and helped me with my project 👍
Why has no company copied the EpiPen earlier? Does Mylan have patents for the device?
I know a few people that rely on EpiPens in the summer in case of a bee sting. As more and more people started to need EpiPens they raised the price of them. Which caused some people to be unable to afford them. It costs very little to make these pens so why do you need to raise the price? Its just so the company can make more money and make a bigger profit off of them. This is very unfair to the people that rely on these pens to save their lives in emergency situations. These pens have an expatriation date and need to be replaced every year. When they first came out the price was $57 now they are over $600. The government encourages the products use but makes little to no effort to control the products cost.
My brother is allergic to all types of fish and must have an EpiPen on him at all times, which is why I clicked on this video on the first place. I can attest to the monopoly Mylan has on the market after watching my parents shell out hundreds of dollars each time he needs to replace his EpiPen. In an ethical sense, I believe the issue of beneficence should be the biggest concern. A quick definition of beneficence is that there is moral obligation to act for the benefit of others. There is no reason that the price of EpiPens has raised over 450% since 2004 other than the fact that it is easy to use and demanded by a large group of people. I feel that Mylan and/or our government has an obligation to set a price that people can actually afford. Instead, people such as my brother are spending large sums of money just to keep anaphylaxis from killing him.
i have a risk for anaphylaxis due to a latex allergy and i work in a hospital so i have to carry an epipen on me, even with insurance i still had to pay 100$
"And Mylan raised the price..." Why do we allow companies to maintain monopoly control over life-saving medicines? Some other company could manufacture the device if there weren't patent protections in place. I'm glad we have insurance to pay for the sets of EpiPens we need each year for my kid.
How would they prevent it? The company doesn't have an enforced monopoly; they're just the only company making the product. This is why healthcare should not be covered by the private sector. At least, not entirely; making a profit for pharmaceutical companies and insurance companies and the public good are not in any way aligned.
I was arguing specifically against the patent protection. I think the patent should no longer be valid. It has been enforced long enough for the original patent holders to make back their investment.
I honor Jonas Salk who refused to patent the polio vaccine because that kind of protection should 'belong to the world'. Honor has become extinct in robber baron capitalism.
The biggest reason that this is an issue is that EpiPens involve a medication that patients who have severe anaphylaxis to specific medications cannot go without due to the risk of death. Although the pharmaceutical companies have a right to make a profit, the ethical relevance of a patient's right to life-saving medications should take precedence. Unfortunately, this is not an easy fix. As the video discussed, there have been several attempts by other manufacturers to produce a similar medication. Even AdrenaClick, which some providers have since taken to prescribing, is not truly an affordable option, although more so in comparison to the ever rising prices of the EpiPen. It is likely that at some point in the future this will involve a lawsuit after a patient dies from an anaphylactic reaction after not being able to afford their medication, however ideally we should come up with a better solution prior to something this drastic occurring. It will be interesting to see how effective pre-filled syringes may be on patient outcomes in the future, although it sounds like this solution is currently farther out than we have time for. The most realistic option would be for another pharmaceutical company to come up with a more efficient generic mechanism to replace the EpiPen, and force Mylan to reconsider their outrageous prices. Additionally, it might be time for the government to step up and force some additional regulations given the serious health risk associated with inaccessibility to this medication.
Jesus, in my county you can get 2 free epipens a year and if you use one because you needed to you get a free replacement yes the alternatives exist for lower prices but there have been cases where they were used incorrectly and ended up "killing" the person with the allergy. I was also wondering what the laws are regarding using epipens in the US are here we are allowed to use an expired or another persons epipen (in a school for example) as long as there are no other options and the persons who's epipen is used is kept under close watch and kept safe until another epipen is available. Is this the same in the US?
I saved a couple hundred dollars by buying another brand (not sure what it is) but I guess it's tip doesn't withdraw after use so you have to be careful not to poke yourself after you use it. I'm not sure how my parents found out about it, but they had to drive to a different pharmacy kinda far away I think. Hopefully I'll never have to find out if it works or not.
I got an Epi Pen Canada ad on this
When there's such a monopoly in other markets, doesn't the government force that one company to split? Why won't they do that with Mylan?
Why don't they just allow intracardiac injections. It'd mean a lower dose and a quicker onset of action. It's not like it's hard. Just go four ribs down and your there.
In Canada, 1 epipen costs about 78 USD and the price has been stable since 2007, because it's not Mylen that distributes it, but a subsidiary of Pfizer's.
FDA: "Buy 2 EpiPens"
Suffocating child: "cough* Regulatory Capture *cough*
Can an Epipen be refilled?
What makes this epipen so expensive? Rnd?
Mylan should be sued
They're not trying to recoup the cost of developing Epipen, they're charging $500+ for "future development of drugs" and for CEO pay.
I see this as an opportunity. Surely one could develop a computer controlled disposable auto-injector that was cheaper. Would that breach the patent on the injection system?
So how is this different from insulin? Is it too much to think we can draw that and store that but we can't with this somehow? I fail to see the difference. Both require planning and changing your lifestyle dramatically.
The difference is with insulin is you're usually not dealing with panic and hypoxia when it's time to administer it.
I guess the big difference is in school. Not every teacher is going to measure things out just right when under pressure. Not every class is going to have a cooler to store the medicine correctly.
Why won't a competing drug maker duplicate EpiPen's pen design? Surely any patent on it would have expired by now if its original release was in 1977?
America needs someone like Margrethe Vestager.
How much training do you actually need to do an emergency injection? A 5 minute training video? A day long course (Like CPR Cert Class)? More?
At one of my old jobs a coworker needed an insulin injection and had gone too long without it so he was all weak and shaking and unable to really speak clearly or walk easily. His kit was back in the truck and he told me he was going to pass out before I got back with it, so just follow the directions on the box and do the injection. The directions consisted of a stick figure showing you how to draw the stuff from the little bottle and where to inject it, literally two pictures and probably 12 words. It was easy, he woke up just in time for the EMTs to reach us.
I am all for the auto-injectors, I'm just curious how much training the syringe method requires. Did I get lucky and just do it right? I mean, the guy lived and was back to work the next day, so... Success?
Guess what the advertisement pre-ceeding this episode was? Epipen Canada!
Mylan is taking advantage of the EpiPens being (basically) the only Epinephrine on the market. Physicians write prescriptions for their patients no matter how rich/poor they are. Poor patients cannot afford to buy EpiPens every year. $600 for 2 EpiPens seem way over priced in our current market. I believe that if Mylan can keep increasing the price of EpiPens, then the patient's insurance should cover more than half of the bill. An EpiPen can save someone's life and no one should have to pay over $100 for it.
This points out the effects of any government created monopoly, which are especially evident in the US healthcare system. Any monopoly in any field is going to raise its price to where its profits are maximized. And the FDA routinely grants monopolies.
In most other countries, the government will set the price. Of course, they can do that, because in most cases the US has already foot the bill for development costs, and the other countries only pay for the marginal cost of production. In effect, the US is paying for the world's drug development.
Solutions to this problem are easy to figure out, ranging from government price controls on monopoly drugs, to limiting the length of the monopoly. But this is a very arcane issue, and I know of no group or association advocating for it. OTOH, drug companies are very well aware of the issue, and lobby Congress incessantly.
wouldn't you think that huge deregulation by the government would also solve the problem? in any industry with little regulation, the free market system lowers price and increases quality.
Of course, when Congress passes legislation mandating an emergency stash of something supplied by only a few firms, we should not be surprised that the market suddenly tolerates a higher price for the higher demanded quantity.
Why is there not a generic version of the EpiPen? The original patent should be expired by now and the drug is cheap and outside of patent so no one else wants to make a generic at half this exorbitant price?
Indonesia have a price at about 52 bucks non prescription. Which is still very expensive in this country's standard but still not a kidney's worth like whatever the US got. If a considered developing country have it way cheaper than you, you know something's wrong
Regulatory Capture. Strict Prescription Rules. Patent Protection. Regulations and Time to Market. Insurance masking the message of price. Legislating preference of a product. Legislation reducing options on insurance.
Yep, those are the problems with medical devices in general and the rest of the US healthcare system... Government Involvement... NOT CORPORATIONS.
How much do you think was spent encouraging the government to keep competitors out of the market?
Same pen in Australia is $38.50aus
The fact that companies can raise their prices with no rhyme or reason is one of the BIGGEST problems in healthcare today. When and where does it stop. I understand medications that are harder to come by, have a lesser need for, or even that aren't used often having a higher cost. But the epi-pen? Shame on Mylan as well as our government for allowing this to happen. I know this is not the only medicine this has happened to also. There are so many people out there that need the epi-pen. And it's not like people choose to have life threatening allergies that make them need this medication. I am curious, how much, if any does an insurance company cover? But that still does not make it right when not everyone even has health insurance. The government needs to take control of this situation because we know Mylan is not the first and will not be the last to take advantage of the need for their medication. No one on this planet should have to go without an epi-pen if they need it. In most cases and forms birth control is free, so why can't epi-pens? Personally, I value the need of an epi-pen more than I do birth control. Epi-pens should be accessible at a low cost, to all people who have a written prescription for them. Especially since they noted that the cost of epinephrine is very low. It should be downright illegal for things like this to happen in our modern day healthcare system.
Sounds like Mylan's has been lobbying hard and slippery.
In Austria everyone has an insurance. So nobody has to pay for hospitals or drugs
There are almost no reasons I would harm another human being. I wouldent think twice if I met those responsible.
This is legally a case of breaking anti-trust laws, but ethically it is one of conflict of interest, one that can be traced right to the top of Mylan. The CEO of Mylan during this drastic rise in the price of EpiPen has been Heather Bresch and according to NBC news from 2007 to 2015 during the time that the EpiPen retail cost rose 461%, while her salary increased by 671%. On the surface this seems a clear case of a monopoly, and possibly price gouging, but it is much more complex and possibly calculated. Heather Bresch just so happens to be the daughter of Sen. Joe Manchin, whom in 2007 was the Governor of West Virginia. Joe Manchin’s wife is Gayle Manchin. Gayle is on the West Virginia State Board of Education, which is an appointed position. Gayle was appointed to that position by her husband, the then Governor of West Virginia for a nine year term in 2007. While on the board, Gayle used her position to lobby for Mylan’s "EpiPen4Schools” program which gave away EpiPens to schools and promoted the idea that schools need to purchase EpiPens. These campaigns then lead to “Eleven states drafted laws requiring epinephrine auto-injectors. Nearly every other state recommended schools stock them after what the White House called the ‘EpiPen Law’ in 2013 gave funding preference to those that did,” according to USA today.
www.usatoday.com/story/news/politics/2016/09/20/family-matters-epipens-had-help-getting-schools-manchin-bresch/90435218/
But what are pharmaceutical corporations’ ethical obligations? Is it to the patients that the medications are being sold to? Is it to the taxpayers, or is it to the corporate stockholders? Because pharmaceuticals are a part of the medical system of care I believe that they should be held to the same ethical standards as doctor and nurses, and not those of profiteering corporations. Aaron Carroll points out that the recoupment for the cost of research and development (R&D) for this particular drug has long been met, and the profit margin well exceeds the norm, but that is not the problem. It is apparent the profits from this price hike wasn’t reinvested in further R&D, it was pocketed by this CEO. The problem is that Mylan’s CEO used the influence of her parents political positions for personal monetary gain on the taxpayers’ dime and at the expense of patients who need this lifesaving drug. This is a clear conflict of interest, in my opinion.
Twin pack in Canada is 240$ , still more affordable than the US