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EpiPen Price Rise Sparks Concern for Allergy Sufferers

well.blogs.nytimes.com

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Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#101

Post by gwright »

rdtsc wrote: post #67
sevenless wrote: post #30

How many people will this price hike kill? I'm sure that's estimable. What would be morally justified, to stop it?

Nah because it would upset the free market. I mentioned in another comment when someone from Europe or Canada asked something to the effect of "how come everything has to be free market in US even healthcare and such". And I think the answer is we treat free market as a religion. We don't evaluate what is better, healthier, more rational answer for a problem. Like say, "How do we keep people from dying from anaphylax…

Why do you and many other characterize this as a free market failure? If anything this is a regulatory failure.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#102

Post by hackuser »

shanacarp wrote: post #41
Cyph0n wrote: post #28

Earlier quoted context omitted.

That second discussion got heated quite fast. I agree with the downvoters though. 3D printing a medical device is not something to take lightly. Edit: Here's why I agree. You download this design from the internet, and 3D print the parts. You then assemble it. Awesome! Some time later, you get an allergic reaction. You use the pen, but it fails to work correctly. Who's responsible? The designer? You (if you're alive)…

Semi-yes, semi-no. The epi-pen case is specially made to try and get people to shoot it into themselves/other people correctly. They are super color coded and once triggered can't be untriggered Other than that, they could be 3-d printed or whatever is cheapest by many providers

Consider also reliability: What if some 3D-printed part breaks? What if it sticks when it gets hot or cold, or after a few hot/cold cycles, or after some flexing in a pocket?

The first 90% of quality is easy ... Think of the difference between the quality needed for a mobile game app and the software that flies airplanes.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#103

Post by Cyph0n »

curiousgeorgio wrote: post #91
Cyph0n wrote: post #28

Earlier quoted context omitted.

That second discussion got heated quite fast. I agree with the downvoters though. 3D printing a medical device is not something to take lightly. Edit: Here's why I agree. You download this design from the internet, and 3D print the parts. You then assemble it. Awesome! Some time later, you get an allergic reaction. You use the pen, but it fails to work correctly. Who's responsible? The designer? You (if you're alive)…

Consider this: every time you get into a car, you are putting yourself into life-or-death scenarios that greatly depend on the class and quality of car you've chosen. The government enforces some minimum safety standards for any registered car on the road, but above that, you pay for safety - quite literally. Does the government prevent the sale of cheaper, inferior cars just because higher-priced cars are substantia…

Firstly, the standards and regulations a manufacturer needs to meet to get even a single car on the road are staggering - probably comparable to FDA approval in complexity. Also, the testing of single components and complete vehicles is extremely comprehensive.

Secondly, there's a huge difference between the two cases that you're not considering: medical devices are designed to interact directly with the human body and alter it from within.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#104

Post by maxerickson »

kasey_junk wrote: post #24
serge2k wrote: post #7

Well you know, they need to recoup the R&D costs to develop the drug. > Mylan, the pharmaceutical company, acquired the decades-old product in 2007, when pharmacies paid less than $100 for a two-pen set Oh. This is why US health care is broken people.

This is one reason. Another reason is that a huge chunk of the population will simply not see these costs. For instance, I choose to be on a high deductible plan at my work (they offer both a high deductible plan and a traditional PPO). My wife has the choice of a reasonably priced HMO and a extremely expensive PPO. On my high deductible plan if I need a refill for an epipen I pay the full boat unless I'm past my ded…

Apparently they'll cover your copay.

https://www.epipen.com/en/copay-offer

(I didn't read it closely, but the eligibility criteria seem to be 'private insurance')

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#105

Post by curiousgeorgio »

hackuser wrote: post #100
curiousgeorgio wrote: post #91

Earlier quoted context omitted.

Consider this: every time you get into a car, you are putting yourself into life-or-death scenarios that greatly depend on the class and quality of car you've chosen. The government enforces some minimum safety standards for any registered car on the road, but above that, you pay for safety - quite literally. Does the government prevent the sale of cheaper, inferior cars just because higher-priced cars are substantia…

> The government enforces some minimum safety standards I think this understates the safety regulations for automobiles by quite a bit. Maybe there's an example of an industry which makes lightly regulated, dangerous products, but I don't think cars are it.

True - the government's automobile safety standards are far from trivial, but there's no denying that the difference in safety between the cheapest smart car on the road and the safest car on the road is huge. In a head-on collision between the two, there's absolutely no contest.

Asking why the government should allow an EpiPen competitor with a 0.1% higher failure rate is akin to asking why the government should allow people to purchase small, cheap cars.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#106

Post by helloworld »

dfsegoat wrote: post #37
Cyph0n wrote: post #28

Earlier quoted context omitted.

That second discussion got heated quite fast. I agree with the downvoters though. 3D printing a medical device is not something to take lightly. Edit: Here's why I agree. You download this design from the internet, and 3D print the parts. You then assemble it. Awesome! Some time later, you get an allergic reaction. You use the pen, but it fails to work correctly. Who's responsible? The designer? You (if you're alive)…

Thanks for this summary comment. This is backed in the literature by people who are systems / usability engineers: tldr: Reliable design is HUGELY important. You can't just put these things together haphazardly. "The fact that less than 50% of participants across all devices could follow the labeled instructions without committing a single error provides confirmation that the need for training on the use of epinephri…

In the study below, moms of kids with severe allergies were trained to use the EpiPen. Six weeks later in a simulated test, only about two out of five were able to successfully deliver a lifesaving dose of adrenaline.

Shouldn't the FDA require that manufacturers provide evidence that consumer medical devices can be used reliably for their intended purpose?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4654245/

Patients’ ability to treat anaphylaxis using adrenaline autoinjectors: a randomized controlled trial. Allergy. 2015 Jul; 70(7): 855–863.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#107

Post by pm24601 »

hackuser wrote: post #100
curiousgeorgio wrote: post #91

Earlier quoted context omitted.

Consider this: every time you get into a car, you are putting yourself into life-or-death scenarios that greatly depend on the class and quality of car you've chosen. The government enforces some minimum safety standards for any registered car on the road, but above that, you pay for safety - quite literally. Does the government prevent the sale of cheaper, inferior cars just because higher-priced cars are substantia…

> The government enforces some minimum safety standards I think this understates the safety regulations for automobiles by quite a bit. Maybe there's an example of an industry which makes lightly regulated, dangerous products, but I don't think cars are it.

gun industry

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#108

Post by Cyph0n »

foota wrote: post #96
ceejayoz wrote: post #93

Earlier quoted context omitted.

> Does the government ban us from purchasing cheaper, inferior cars just because higher-priced cars are substantially safer? Yes?

But also no, I can be a used car with lower safety features than mandated for new cars I believe

In that case, there is no ambiguity when it comes to determining who's responsible, unless the DMV or whoever allowed you to drive it.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#109

Post by derekp7 »

DSMan195276 wrote: post #87
ccleve wrote: post #47

Earlier quoted context omitted.

> So, The FDA, because they require drug and device makers to demonstrate efficacy and safety by going through a rigorous clinical trial process, are evil? Really? Yes, if the process is so rigorous and expensive that it drives the cost of drugs beyond the reach of people who need them, and it hampers the effective functioning of the free market. And I think it's widely accepted that's far more expensive to bring a d…

I don't really think you know all the history here. There are other companies who have/are attempting to create competitors to EpiPen. A few of them weren't able to get passed by the FDA, and one of them passed the FDA in 2012 but was recalled because of the product misfiring. The EpiPen problem seems to be much less an FDA problem then it is a problem with manufacturing, other companies don't seem to be able to make…

What about buying 5 of them that are $20 bucks a piece? Maybe they can be made in a stackable format, so it would be easy to carry 5 of them. If one misfires, snap it off and use the next one in the stack.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#110

Post by Ironchefpython »

gwright wrote: post #99
cortesoft wrote: post #55

Earlier quoted context omitted.

Yes; this is why using the free market to set prices in health care is always such a troubling thing. People don't like the idea of putting a price on their health.

Please don't blame the free market for these high prices. This is a highly regulated medical device market with patent protections and insurance market complications. The price hikes would immediately attract lower-cost competitors if this were truly a free market.

> The price hikes would immediately attract lower-cost competitors if this were truly a free market.

Any participants in a free market for a product with inelastic demand (e.g. something you need to stay alive) and non-trivial entry costs immediately implements price fixing in the absence of regulation.

When life-saving devices that require a significant supply chain to manufacture capture the bulk of consumer surplus from the majority of potential customers (and the poorest are left to die), the free market is working as intended, efficiently allocating resources to maximize profits.

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