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08/29/2016

The $280 Better Mousetrap

The rising cost of the Mylan EpiPen has been in the news. Since 2007, Mylan has raised the cost of their two pack EpiPen from just under $100 to over $600 today. That is a cool $300 per EpiPen, substantially above the ten to twenty dollar retail cost of the raw material epinephrine. Why should I be asked to spend a $280 mark-up? Is this ethical?

Briefly, here is some background. Adrenalin, pharmacologically known as epinephrine, is a substance that your body releases in response to stress. It allows the body to handle emergencies by the so-called “fight or flight response”. Large doses can be lifesaving, as is the case with allergic reactions. Individuals with allergies to peanuts or bee stings can receive epinephrine via an injection under the skin or into a large muscle, which can delay or even eliminate a life-threatening anaphylactic reaction (allergic swelling so widespread that an individual cannot breath or maintain their blood pressure), usually allowing time to travel to the ER for further care.

The EpiPen is one method of administering the epinephrine. An individual simply grabs the device, shaped like a stick, and jabs the end of the stick against his or her thigh muscle. This causes the EpiPen to release a spring-loaded needle, extending the needle into the thigh muscle, delivering a fixed dose of epinephrine into the muscle. The device is very easy to use, so much so that a young child can be taught to use the device safely and reliably.

One does not need to use an EpiPen to self-administer epinephrine. I checked with my local pharmacist and he can set me up with a syringe, needle and vial of epinephrine, and, as long as I can draw up the correct dose, and, as long as I am not squeamish about giving myself an injection in my thigh muscle, I can administer the exact same life-saving dose of epinephrine as the EpiPen. The total cost is around ten to twenty dollars per dose. Many other drugs, most notably insulin, are both self-administered and life saving, so nothing novel is required here. Additionally, according to my pharmacist, the “purse-life” of the generic vial of epinephrine extends several months beyond the one-year limit of the epinephrine in the EpiPen.

In short, Mylan is asking you to pay $280 for the privilege and convenience of using their stick to administer epinephrine rather than doing it yourself. Presently, there are no other options. Mylan’s only other competitor, Sanofi, withdrew in October 2015 their version of the EpiPen, called Auvi-Q, after multiple reports of failing to reliably deliver the correct dose of epinephrine. The present lack of a competitor seems to suggest that Mylan has indeed built a better mousetrap. They seem to be feeling a little guilty about their market dominance, as they have just today promised an identical generic EpiPen at half the cost.

Mylan’s mea culpa aside, is it ethical for them to charge whatever the market will bear, not for the epinephrine, but for the convenience of administering the epinephrine?

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