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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

#111

Post by hackuser »

bottled_poe wrote: post #79
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…

> it should undertake a rational risk/benefit approach. Rather than saying that no drug gets through the filter unless it's safe (as demonstrated through reams of evidence), it should ask, how much risk should we tolerate in exchange for how much benefit? Do you really believe the FDA isn't doing this? The price of these drugs is directly linked with the risk*cost of being sued. In order to reduce the cost of the dru…

> The price of these drugs is directly linked with the risk*cost of being sued

Generally, prices are set to whatever will maximize profit. In the 'free market', nobody with any sophistication prices things based on cost. It's a fundamental of microeconomics.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#112

Post by MarkPNeyer »

schmidty wrote: post #81
rdtsc wrote: post #67

Earlier quoted context omitted.

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…

How is government protecting a monopoly free market exactly?

EXACTLY

A free market would mean anyone who wanted to to create one of these.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#113

Post by maxerickson »

robryk wrote: post #71
ucaetano wrote: post #52

Earlier quoted context omitted.

No it doesn't. Switzerland has one of the best healthcare systems in the world, which is completely private (although there are some public hospitals), but heavily regulated.

Alas, there are significant differences between the Swiss and US one. Most importantly, law in Switzerland specifies exact coverage criteria for basic health insurance and prohibits excluding pre-existing conditions from it. I'm not sure how financing of hospitals works exactly (I was under the impression that they are at least partially publicly owned). Minor things: there are phone-a-doctor public services that are…

The ACA standardized basic health insurance and prohibited excluding pre-existing conditions.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#114

Post by jevinskie »

gradstudent wrote: post #68
xnor wrote: post #42

If people don't want to buy two epipen there's always that neat trick for multiple doses in precarious locations far from hospitals. It is a well known hack taught in wilderness medicine training. https://www.youtube.com/watch?v=luultUD0eK0

If you have something concrete to say then say it. You're only lowering the quality of the conversation by making vague assertions in the style of "one weird trick" followed by mystery links to random places on the web.

This "one weird trick" may save your life if you experience anaphylactic shock and do not have multiple auto-injectors available, for whatever reason (cost, some have expired, remote location, etc).

I discovered this technique a couple of years ago and was interested in it. I tried replicating the use with some expired autoinjectors. As far as delivering subsequent doses, I was able to reliably deliver 2+ more doses (into oranges) from my expired injectors. I feel better prepared for an emergency now.

I have never needed to use my autoinjector. I had one incident where I was very close to shooting up my thigh but the symptoms were just "mild" enough that I did not. I met another person with severe food allergies at THOTCON this year who described to me in detail two separate incidences where he felt it was necessary to administer two doses. I hadn't really given much thought to multiple doses before hearing his stories (one of which included a medically induced coma). Now I make sure to have at least two doses on hand. My doctor certainly didn't express to me the potentially dire necessity of multiple doses!

Of course, this bushcraft advice doesn't hamper my cautiousness about having autoinjectors around everywhere I may need them. I have a pair at my home, my office, my parents home, and my backpack (always with me when I travel). Eight autoinjectors, that need scheduled replacement, is a luxury I can afford. Others may not be so lucky and may be helped by these bushcraft techniques.

I do need to research the issue more though because my insurance currently covers eight autoinjectors (not EpiPen brand, but a "generic"? Lineage Therapeutics brand [0]) at the rate of $15 per two 0.3 mg injectors. I'm not sure if I'm lucky, have great insurance, or what.

[0]: http://www.epinephrineautoinject.com

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#115

Post by gwright »

slowmovintarget wrote: post #64
shanacarp wrote: post #39

This is one of those devices that also should be low cost because businesses, locations, ect should have them as well as individuals (many people can have first time deadly allergic reactions, including as adults) That the price for the case is expensive just rose as random is serious business. There really is no need for it to be so expensive

I have no evidence, but this headline coupled with the insulin price hike... it really feels like this is an attempt to manufacture a crisis. I fill a prescription for epi-pens once a year (nut allergies), but insurance bears the brunt of the cost.

Insurance simply distributes the high cost to many people via higher premiums. Without competition to reduce the cost or regulations that set the price by law, the high cost remains.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#116

Post by refurb »

cortesoft wrote: post #55
hkmurakami wrote: post #50

Earlier quoted context omitted.

Not condoning this behavior at all, but don't we see this with the lack of equal access to drugs all the time? :(

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.

People don't like the idea of putting a price on their health.

They don't like it, but healthcare costs money and money is a limited resource. That's reality.

In the US system it's the insurance companies that limit access (or the cost to an individual). In other countries it's the gov't.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#117

Post by refurb »

actuallyalys wrote: post #86
hkmurakami wrote: post #50

Earlier quoted context omitted.

Not condoning this behavior at all, but don't we see this with the lack of equal access to drugs all the time? :(

Yep. :( We also see drug shortages because the lone manufacturer temporarily or permanently stops manufacturing. For example, there's an ongoing injectable estrogen shortage because the manufacturer has an issue sourcing a key ingredient [0] [1]. (Thankfully, other forms and dosages are not impacted.) [0]: https://www.theguardian.com/commentisfree/2016/aug/13/estrog... [1]: http://www.out.com/out-exclusives/2016/8/04…

One of the reasons for drug shortages is because it's just not profitable to produce the drugs when you roll in all the regulatory costs.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#118

Post by refurb »

helloworld wrote: post #106
dfsegoat wrote: post #37

Earlier quoted context omitted.

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/ Patient…

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

What makes you think the FDA doesn't require this?

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#119

Post by chiph »

Terr_ wrote: post #72
xnor wrote: post #42

If people don't want to buy two epipen there's always that neat trick for multiple doses in precarious locations far from hospitals. It is a well known hack taught in wilderness medicine training. https://www.youtube.com/watch?v=luultUD0eK0

So a "used" epi-pen's internal syringe might contain 4-5x more epinephrine than actually goes into a standard dose? I assume this means most of the expense of making it comes from the housing/mechanics. (And recouping whatever cost of QA/approvals.)

I haven't worked with this class of medical device, but I expect the major cost of the unit is in the approvals and lawsuits.

So far as the pen itself - They've got some injection-molded plastic, where the mold costs are amortized across the production lifetime. A needle + syringe, which are probably subcontracted from Becton Dickinson. A spring. A printed label. And the medication itself (probably the #2 cost).

The assembly of the above all had to conform to the FDA's Good Manufacturing Practices rules. Every part & ingredient had to have trace-ability to their source. With documentation thereof.

When we got our device approved (in a looser classification than this) we had to get UL approval ($50k per test, per device, per test-run), and we had 3 people on staff whose sole purpose was navigating the FDA paperwork and their approval process. I never heard what that cost was, but it was substantial. And then we had an IP attorney, and corporate defense attorneys to respond to the inevitable lawsuits.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#120

Post by kasey_junk »

maxerickson wrote: post #104
kasey_junk wrote: post #24

Earlier quoted context omitted.

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')

I don't have a copay on epipens, but I do have a deductible. This actually can help me but the max is $100 off of full price (a few years ago I got $75 off with a similar card).
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