The Gecko Says

The High Cost of Not Dying

PaulAmador - Copy

The recent press regarding the pharmaceutical company Mylan and the criticism of price gouging for the EpiPen has brought forth – in an election year where debates about the cost of healthcare rage almost daily – significant negative press towards Big Pharma. Now there are talks of impending investigations into Mylan’s business practices which will no doubt cascade throughout the pharmaceutical industry as similar pricing practices are uncovered.

Let’s recap the Mylan incident from this week.

Mylan manufactures the EpiPen product which is widely used to fend off severe allergic reactions and fatal anaphylaxis in adults and children. It is dispensed – as the name suggests – in an easy to use auto-injection device resembling a pen. This week it is being revealed that Mylan had increased the cost of a two-pack of EpiPens to a whopping $600 which is an estimated 400% increase since 2009. Let us just note here, that the EpiPen contains about $1.00 in epinephrine and the auto-injection pen costs a few dollars more. 1

I would like to add that I happen to have an allergy to whitefish where even a small amount ingested could be potentially fatal. Fortunately, my wife Alycia happens to be a Family Nurse Practitioner (FNP) and carries an EpiPen with her at all times in case of such an emergency. Consequently, this particular news item struck a very personal chord with me.

To be fair, in the backlash of this controversy, Mylan has offered to cover $300 of the cost of the EpiPen but still leaves many families to cover the remainder out of pocket.

While there are alternatives to the EpiPen, not all of them possess the rapid delivery system. Further, with the increase in food allergies among children, families have to provide pens to schools and caregivers on a regular basis. And as with all medicines, EpiPens have a specific shelf-life. Even with good health care insurance this life saving medicine can still cost hundreds of dollars each time the prescription is filled.

According to eight foods account for 90 percent of all reactions: milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish.; and like myself, even a small amount can cause a life-threatening reaction. This makes affordable access to this medicine paramount. We’re not talking dollars and cents here; we’re talking human lives.

Why does there seem to be an increase in food allergies? There is no definitive answer as of yet. I have my own theories but I’m not a scientist or a physician so I’ll keep those to myself for now. The facts though are this: food allergies affect 1 in every 13 children. So look up and down your street or do a quick headcount in the average American classroom, take a quick tally of children under 18 and you’ll start to see the wide ranging effects of food allergies.

As if the price hikes of 400% from 2009 weren’t enough, the secondary backlash of the Mylan fiasco was when it was revealed the CEO of Mylan, Heather Bresch earns a staggering $25.8 Million in salary per year. When you see and hear of American families (remember the 1 in every 13 children under 18 with a food allergy statistic?) struggling to make ends meet and yet we see a CEO earning that level of salary, those of us not in that income bracket begin to understand that Big Pharma has indeed – and quite literally – put a price on human life.

Let’s take a quick glance at another life-saving medicine that is on the fast track to disaster – insulin used to treat Type I and Type II diabetes.

For Type II diabetics, most medical professionals will agree the disease can be controlled via diet and exercise. There are of course cases where it cannot and then insulin is required to control blood sugar and A1C levels. Type I diabetics don’t have a choice. They must administer insulin on a regular basis to maintain healthy blood sugar levels or risk severe health issues and possibly death.

Depending on one’s insurance coverage, a 30-day supply of Novalog insulin can run about $110. There are other, cheaper insulins but I’m using this one as an example. Many Insurance companies require Medical Professionals to prescribe a 90-day supply which even I can do that math – $330.00 all at one time. If the diabetic also requires long-term insulin, cap on another $300.00 for a 90-day supply and pray you don’t break a glass vial or accidentally leave the insulin pen on the >90F or dashboard of your car.

By way of comparison, a 30-day supply of Oxycodone (5mg tablets) is going to cost that patient – again, depending on insurance – about $45 per month.2

Antidepressants can potentially be even less expensive. In some cases, the generic versions of Wellbutrin, Zoloft and Effexor can be less than $3.00 for a 30-day supply.

I’m not saying people with chronic pain don’t need relief and people with depression don’t need treatment.

What I am doing is contrasting the cost of lifesaving medicines against the cost of other medicines that have perhaps been on the market just as long; but Big Pharma can control the supply and the overall cost because they can. The significantly lower prices of controlled substances such as Oxycodone almost encourage abuse and misuse. 3 In cities across the nation the rampant over-prescribing of Opioids and its companion drugs are reaching epidemic proportions.

It’s no secret that in the U.S. some drugs can take 10-15 years to make it to the general public. Traditionally drug patents last 20 years before generics can be manufactured. It’s also well known that the FDA has some of the most stringent regulatory controls in the world when it comes to releasing drugs to market. Many would submit that this encourages Big Pharma to price gouge.

At what point does Mylan recoup the Marketing, Research and Developments costs for the EpiPen? Is it possible for a pharmaceutical company to be altruistic when it comes to saving actual lives after they’ve made back the money they’ve put into creating a medicine? Or is it a numbers game where some medicines just take years to develop only to be rejected by the FDA because they fail clinical trials? Thus isn’t Big Pharma hedging their bets on a horse that isn’t even born yet?

I think we all agree that business is business and in the United States we’ve adopted a capitalistic society and economy. It’s what’s made us the most powerful and admired country on Earth. However, with the backs of the middle class straining to maintain a basic quality of life and give their children what I believe most parents want to provide – which is a healthy and better life than they themselves had – when do we rise up and say “enough is enough”? At what point do we ask these companies to be held accountable when they intentionally put lifesaving medicines and healthcare out of our reach or force someone else to decide whether today their loved ones get to eat, or get to take their medicine?

Why should our children, our elderly and ourselves be indentured to Big Pharma when all Big Pharma is doing is placing an ever growing price tag on the cost of not dying?

Be safe.

  • The Gecko

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P.S – Many thanks to my wife Alycia Ernst Amador, FNP, APHN for helping with the research for this article.

P.S.S. Here’s some further reading in your spare, spare time. In case I haven’t made you mad enough. 😉

Patient Access to Epinephrine Auto-Injectors: A Matter of Live and Death:

Food and Allergy Research and Education:

Mylan Rolls Out New EpiPen Access Plan:

Feeling the Pain of Costly Prescription Drugs

Company that hiked drug price 5,000% investigated by U.S. Senate:

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