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EpiPen Price Rise Sparks Concern for Allergy Sufferers

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Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#151

Post by gwright »

rdtsc wrote: post #125
gozur88 wrote: post #94

Earlier quoted context omitted.

I'm pretty sure you could put together epinephrine and a syringe for a few bucks. And sell it for twenty or so with a healthy profit. But you can't, can you? Is that because of free market worship, or worship of the regulatory state?

> But you can't, can you? Yes you can! Believe it or not this completely unregulated free market utopia exists. It is not just a fantasy. Now don't get excited, I imagine after I tell you about you it, you probably won't be headed to the airport to go there -- that's because it is actually horrible. Unregulated market is what was (and is) happening in any of the post-Soviet republics, Russia, probably China, probably…

I'm sure there are some people that truly want the unfettered, caveat emptor world that you describe, but I think that is a mischaracterization of what most free-market advocates are actually talking about.

The type of regulations/laws are hugely important. Critical statements regarding existing regulations are not the same thing as advocating for no regulations whatsoever.

I think it is more useful to view calls for a 'free market' to really be calls for a 'minimally regulated market'. For example, regulations and laws that penalize fraud and negligence are well within the scope of a 'minimally regulated market'.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#152

Post by jevinskie »

helloworld wrote: post #2

Why haven't competitors entered the market with cheaper products?

I'm confused about this myself. I used to receive EpiPen brand auto-injectors. At some point, I started receiving Lineage Therapeutics auto-injectors (supposedly an Adrenaclick generic) instead. According to [0] they are _not_ equivalent to EpiPens according to the FDA. I'm not sure if my primary care physician or my old pharmacist (CVS chain) are at fault for not informing me of the differences. My generic prescription costs me, with insurance, $15 for two 0.3 mg autoinjectors. Insurance has covered four twin auto-injector packs (8 individual auto-injectors total) without any hassle.

Either way, I have trained and informed myself on the proper use of the generic Adrenaclick auto-injector. From what I gather, the main differences are that there are two safety covers on both sides of the injector (instead of a cover on just the non-needle side) and the method of determining whether a dose was supposedly administered correctly (mainly, the EpiPen's needle cover is extended vs just observing an extended needle on the Adrenaclick). I am left to presume that their therapeutic effectiveness is the same, even though the FDA may not explicitly declare it as so. I will consult my physician and current pharmacist (local, non-chain pharmacy with excellent focus on patient care) to determine if I have any misunderstandings.

I have also trained the people most likely to administer epinephrine to myself (family, friends, coworkers) the particular procedures of Adrenaclick administration, so I am not too worried about procedural differences between EpiPens and my generic auto-injector.

Still, I am left wondering what the therapeutic difference between an EpiPen and a generic Adrenaclick alternative really is. I do understand that different administration procedures are a problem for training, but I would expect the actual therapeutic effects of both auto-injectors to be similar --- if used administered according to directions.

[0]: http://www.pharmacytimes.com/p2p/p2pepinephrine-0910

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#153

Post by gwright »

ancap wrote: post #144
gwright wrote: post #115

Earlier quoted context omitted.

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.

>or regulations that set the price by law, the high cost remains It is important to note that even such a law does not magically remove the high cost. Certain products have a high price for a reason and setting the price by fiat is guaranteed to cause shortages. That's when people really start dying. See Venezuela for a prime current example.

This is a very important point! If the fiat price is below the market price, then you are correct, shortages (or simply no product at all) are the result. If it is above the market price then the surplus is captured by the seller rather than retained by the buyer.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#154

Post by JshWright »

invaliddata wrote: post #146

The adrenaclick generic is much cheaper than the epipen, with or without insurance. Although technically different epinephrine auto injectors cannot be substituted (you can only be prescribed the one written by your doctor, or its generic equivalent), practically speaking the only difference between the epipen and the adrenaclick design is the instructions for use. I would hope there isn't a case of doctors being una…

I don't understand why a prepackaged vial/syringe kit isn't readily available for epinephrine. It works just fine for glucagon...

http://www.childrenwithdiabetes.com/d_0n_022.htm

We're literally talking about $1 worth of epinephrine, a $0.50 syringe, and a couple cents worth of injection molded plastic case...

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#155

Post by jevinskie »

invaliddata wrote: post #146

The adrenaclick generic is much cheaper than the epipen, with or without insurance. Although technically different epinephrine auto injectors cannot be substituted (you can only be prescribed the one written by your doctor, or its generic equivalent), practically speaking the only difference between the epipen and the adrenaclick design is the instructions for use. I would hope there isn't a case of doctors being una…

My doctor/pharmacy was apparently unaware of the differences or neglected to inform me. At some point in the last 4 years I started getting generic Adrenaclicks instead of EpiPens. The difference between EpiPens and generic Andrenaclicks was never presented to me as a different choice in medications, just an "expensive brand name" vs "cheap generic" choice. I wonder who screwed that one up.

I did notice the different usage directions (mainly two safety caps with the generic vs one for the EpiPen) but never thought that the FDA considered them to not be equivalents. At least I made sure to carefully read the administration instructions and have trained with dummy, training auto-injectors and expired, real auto-injectors!

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#156

Post by JshWright »

gozur88 wrote: post #94
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…

I'm pretty sure you could put together epinephrine and a syringe for a few bucks. And sell it for twenty or so with a healthy profit. But you can't, can you? Is that because of free market worship, or worship of the regulatory state?

> But you can't, can you?

Why not? It works for glucagon (which is even more complicated, since it has to be reconstituted from a powder).

http://www.childrenwithdiabetes.com/gifs/products/GlucaGenA1...

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#157

Post by gwright »

rdtsc wrote: post #138
jdpedrie wrote: post #83

Earlier quoted context omitted.

That's silly. How do you propose to "evaluate what is better, healthier, more rational"? I suppose some panel of experts could give you their best approximation, but it will always be sub-optimal. Markets exist in order to answer these questions, and they answer them by delegating the decision to every person involved in the decision, not by hoping a designated person can make a guess that's close enough. It appears…

> Markets exist in order to answer these questions, Well in this case it answered that the price should be $600. This means people, kids, astamatics are going to die at some point in higher numbers because of that. I say the market is drunk or evil and should not be allowed to make medical decisions. But because it has a religious following, we don't want to make it angry so we can't say "we mandate EpiPen cost to be…

Setting prices via administrative fiat doesn't eliminate problems. If the price is set to low, there will be shortages or no product at all. If the price is set to high, then the blame for the high price is shifted to the legislature rather than the supplier.

In any case, it is the government that is creating the conditions that allow the price to be set so high in this case. Blaming the 'market' for adjusting to the conditions created by government is confusing cause and effect.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#158

Post by helloworld »

refurb wrote: post #150
helloworld wrote: post #124

Earlier quoted context omitted.

The fact that three out of five people trained to use this lifesaving product weren't able to.

That doesn't mean the FDA doesn't ask for data. I have a friend who works in the industry and it's his job to run usability trials for medical devices. The FDA won't approve a device without it.

You're right. With some Googling, I learned that the FDA does indeed have a "Human Factors Pre-Market Review Process."[1]

But for EpiPen, it seems that the process didn't work, because 60% of consumers apparently can't use the device reliably. I hope that EpiPen is an anomaly, and not typical for FDA-approved lifesaving consumer medical devices.

[1] http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidanc...

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#159

Post by JshWright »

ancap wrote: post #144
gwright wrote: post #115

Earlier quoted context omitted.

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.

>or regulations that set the price by law, the high cost remains It is important to note that even such a law does not magically remove the high cost. Certain products have a high price for a reason and setting the price by fiat is guaranteed to cause shortages. That's when people really start dying. See Venezuela for a prime current example.

There is no supply side reason for the high price Mylan is charging for EpiPens. It is a couple bucks worth of materials (plus QA, distribution, and all that). The R&D costs have long since been amortized away to nothing.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#160

Post by jevinskie »

Mandatum wrote: post #89
kabdib wrote: post #78

If your kid is allergic and needs an EpiPen (or something like it), most school districts will not allow the child to attend class unless they have one at the school. Maybe two. And of course you have to carry them. There's another two. So that's $2400. Out of pocket if you don't have insurance, or if your insurance doesn't pay. The EpiPen manufacturers are abusing their monopoly.

Given the proper age, teaching kids to use syringe/vials or having a school nurse that can administer epinephrine would be a much cheaper alternative. EpiPens are purely about the delivery mechanism. Stabbing a syringe into your thigh and injecting a predetermined amount of epinephrine into your leg isn't majorly complicated. Maybe having a single pen on the kid and vials/syringes at the school would be a cheaper opt…

I've never used an auto-injector on myself before. I have used expired auto-injectors on oranges and potatoes to make sure that I have a "real feel" for how the hypodermic needle really injects. The trainer injectors certainly don't teach you what that is like!

Having said that, I would vastly prefer an auto-injector compared to a syringe + vial. I'm not sure if I would have the proper composure/state of mine, let alone the visual acuity (eyelids swell up real bad during anaphylactic shock) needed to operate a syringe and vial during an episode of anaphylactic shock.

In more controlled situations like at a school nurse's office, where the patient isn't the administering the epinephrine to themselves, I can see the syringe and vial solution to be appropriate.

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