Skyrocketed cost of EpiPen upsets Valley families and pharmacists

Brenda Elensky of Fresno has two children who have allergies.

Her daughter, Rachel, 8, had her first allergic reaction to food before she could barely walk. Her son, Dathan, 17, had an allergic attack about five years ago.

Each had to be rushed to the hospital for lifesaving care.

Now Dathan and Rachel each carry an EpiPen, a prefilled injection device that dispenses the hormone epinephrine, which can rescue a child or adult from anaphylactic shock that could be deadly.

The Elensky children are never without an EpiPen, and all told, the family needs five of the devices. Dathan carries one and has one at home; Rachel has one at school, one at an after-school program and one at home.

Elensky hopes the price for an EpiPen pack (each pack contains two injectors) is not $600 when she needs to replace one that will expire in April. The price of the EpiPen has soared this year.

The family has health insurance through an employer, but Elensky said sometimes it’s a struggle to get the company to pay for the EpiPen. And the price increase concerns her. “You don’t want to lose your child, and you have to have this.”

She is not the only one worried about the steep increase being charged by Mylan, manufacturer of the EpiPen.

“Between January 2014 and July 2016, the price has gone up 98 percent. Basically it doubled,” said Richard Sakai, director of pharmacy at Valley Children’s Hospital. “That is a challenge for all of us who have patients who need this medication.”

Sakai said there is little incentive for Mylan to drop the price of the EpiPen. The company has little, if any, competition. “A couple of years ago there used to be multiple companies, but one had some manufacturing issues and they pulled their model off the market.”

And what is frustrating is that the EpiPen is a wonderful device, Sakai said. The dose of epinephrine is premeasured, and it’s relatively easy to use.

Last week the maker of the EpiPen offered to help patients pay for the costly device by expanding patient assistance programs so that a family of four making up to $97,200 would pay nothing out of pocket. It also will offer $300 co-pay cards, up from the current $100 per-prescription savings. That would cut a patient’s bill in half for those who have to pay full price.

But the offer by Mylan has not been met with enthusiasm and comes at a time when reports of Mylan CEO Heather Bresch’s soaring salary has been met with outrage. According to The New York Times, in 2007 when EpiPen was acquired, she earned about $2.5 million in total annual compensation as an executive officer. In 2015, her compensation was nearly $19 million, The Times said.

Coupons and discount cards may save some people money, but insurance companies will be charged the higher price for the drug, which will cause them to increase premium rates to consumers, said Randy Asai, general manager at Ray Fisher Pharmacy in Fresno.

Institutions also have to stock the device in case of emergencies, Asai said. “We sell to the Boy Scouts every year, at our cost.”

California also pays for the EpiPen for patients on Medi-Cal, the state-federal insurance for low-income children and adults. Typically, Medi-Cal restricts the prescription to two packs yearly.

Mylan provides schools in California with the EpiPen for use in case of an allergic reaction by a child or adult. At Fresno Unified, each school gets four of the devices (two adult strength and two pediatric strength). But parents of children with known allergies must provide the injectors that their children bring to school.

There is no exact duplicate for the EpiPen, but one alternative is Adrenaclick, a device that is similar.

The price differential between Adrenaclick and the EpiPen is dramatic. For example, according to GoodRx.com, which helps consumers shop for low drug prices, Adrenaclick sells for as low as $144.62.

But there has not been much demand for Adrenaclick, and it appears the injection device works differently than the EpiPen. Customers switching from the EpiPen would need to be trained how to use the device by a pharmacist or doctor, said Jennifer Toy, a clinical pharmacist at Kaweah Delta Medical Center in Visalia and an assistant clinical professor at the Fresno medical education program run by the University of California at San Francisco.

Dr. A.M. Aminian, a Fresno allergy specialist, said the EpiPen is the best tool available for his patients. He has hundreds in his practice who rely on the device as a lifesaver.

What frustrates him is that epinephrine, the medication in the EpiPen, is cheap. Doctors and nurses administer epinephrine through a syringe. “You can buy 10 doses of this medication that we use in the office for much, much less,” he said.

Even with coupons, some of his patients now could be hard-pressed to pay for an EpiPen, he said.

“As an allergist, I am very unhappy. I’m very disturbed and I’m very saddened, and I hope the government will do something about it.”

This story was originally published August 28, 2016 at 11:00 AM with the headline "Skyrocketed cost of EpiPen upsets Valley families and pharmacists."