Cash Price of Epipen ... INSANITY!!!!!

[becca]

About expiration...cross posted.

https://www.washingtonpost.com/news/wonk/wp/2016/09/27/why-epipens-expire-so-quickly/?postshare=1991474999508059&tid=ss_fb

[name]

AYFKM.  Not enough of a lesson learned with Mylan?  Icarus much?  I'm so incredibly glad there's NO RELATIONSHIP between the advisory board and Aimmune.  I'm sure 'Dan' rode the Tardis in from another dimension with no Aimmune overlap whatsoever.  For the record, I have zippo to do with that wack OIT101 group riding my posts.   

Good to know you're pleased, James. 

Until resigning to become Chief Medical Officer of Aimmune, Dr. Adelman was a member of the prestigious Research Advisory Board of Food Allergy Research & Education (FARE), the world's largest private funder of food allergy research. For several years, he was actively involved in reviewing FARE's research funding and helped to shape the organization's overall research strategy.

"We're deeply grateful for the contributions Dan has made as a member of our Research Advisory Board, and we're pleased to see him join Aimmune," said James R. Baker, Jr., M.D., FARE CEO and Chief Medical Officer. "Dan's leadership and clinical expertise will be great assets as Aimmune continues to progress toward what would be the first FDA-approved oral immunotherapy for food allergies. This treatment could make a great impact on the lives of millions of people at risk from peanut allergy."

For timeline purposes this was released right before Epigate really blew up.  Dated Jun 21, 2016.

businesswire.com/news/home/20160621005527/en/Aimmune-Therapeutics-Appoints-Daniel-Adelman-M.D.-Chief

[ajasfolks2]

Pretty interesting.

http://www.mercurynews.com/2016/10/01/epipen-outrage-silicon-valley-engineers-figure-true-cost-to-make-lifesaving-auto-injector-about-10/

[spacecanada]

As Ciel did, I am reporting the cost of my EpiPen refill in BC, Canada: $0 with third party medical insurance.  (It is a VERY good policy. No fee except for brand name drugs.)

Without insurance coverage, it would have been $102.64 with a prescription or $95.65 over the counter (no $6.99 dispensing fee.) This was about the same price I paid for a refill in March in Alberta.

My expiration date was January 2017, however, which made me a little upset (4 months, seriously?) but with no cost refills it doesn't really matter to me one way or the other. 

[Penny]

New Zealand - my Epipen was about US $120 six months ago.  Epipen isn't subsidized by Pharmac - our national healthcare meds program....so I paid the full OTC price.  Epinephrine and syringes are subsidized for about US $3.  It's my understanding that low income children are provided Epipens at no cost. 

[name]

CMS sends notice to Mylan, plus mention of potential False Claims Act prosecution.  Notwithstanding the multiple state antitrust investigations of Mylan, this isn't anything different than mentioned upthread.  What I'd be worried about now is how it resolves.  If you look at Bear Stearns, Lehman, Madoff, you'll see a pattern of collapse rather than recovery because things have gone so far it's almost impossible to recover money spent.  I'm sure Bresch can walk away with a golden parachute.  Remember, daddy's a US Senator and mom was high level executive in the National School Boards Association.   We can't wish for collapse because we have none of the autoinjector choices available in more diverse markets (like Jext, Emerade).

The problem as I see it is the complexity FARE should have not introduced by blind support to Mylan pushing for the epinephrine school legislation.  The legislation itself is great: the implementation lacked some basic planning and foresight.  At the very least those non-compete contracts should have been scrutinized within the context of a near monopoly looming.  While no one can forecast this is what is required of basic policy planning.  If FARE does not soon resolve its conflict of interest with another for-profit pharmaceutical, I may consider writing to request a congressional investigation.  Good faith doesn't negate destabilizing the market, or manipulating it even if there isn't a high level of intent in the early stages.

Federal government: Mylan has been overcharging for EpiPens

seattletimes.com/business/federal-government-mylan-has-been-overcharging-for-epipens/

[hezzier]

Not sure if this is where we want this...but Auvi-Q might be back sooner rather than later

https://robynobrien.com/auvi-q-auto-injector-returns-life-threatening-allergic-reactions/

[Puddles]

As Ciel did, I am reporting the cost of my EpiPen refill in BC, Canada: $0 with third party medical insurance.  (It is a VERY good policy. No fee except for brand name drugs.)

Without insurance coverage, it would have been $102.64 with a prescription or $95.65 over the counter (no $6.99 dispensing fee.) This was about the same price I paid for a refill in March in Alberta.

My expiration date was January 2017, however, which made me a little upset (4 months, seriously?) but with no cost refills it doesn't really matter to me one way or the other.

When purchased OTC, isn't tax added? There was something my doctor prescribed many years ago, and it was cheaper as a prescription because the tax was higher than the dispensing fee.

[ajasfolks2]

Allergic Living re: return of AuviQ

http://allergicliving.com/2016/10/26/auvi-q-makers-announce-relaunch-of-talking-auto-injector/

[spacecanada]

When purchased OTC, isn't tax added? There was something my doctor prescribed many years ago, and it was cheaper as a prescription because the tax was higher than the dispensing fee.

Possibly.  I am not sure which taxes would apply: 5% GST would be cheaper than the dispensing fee, but if you had to add the 7% PST (in BC) on top of that (making 12% total tax) the prescription would be cheaper... Still cheaper than in America though.

[Puddles]

I'm not sure what taxes are included either. And 6.99 is the low end of dispensing fees.

[PurpleCat]

Allergic Living re: return of AuviQ

http://allergicliving.com/2016/10/26/auvi-q-makers-announce-relaunch-of-talking-auto-injector/

THIS!!!!

Makes me so very happy!  Saw it all over Facebook this morning and have been smiling all day about it.  If all goes well, DD can have those for college!

[spacecanada]

Has there Beene muh of an update on this whole Mylan and EpiPen cost issue? Any efforts to truly lower the cost to patients? Not insurance loopholes, not discount cards, but actually lowering the full cost?

It seems to have fizzled out in the media and I don't really see and quantitative results. 

[GoingNuts]

From Medscape - Another Look at the Cost of EpiPens

(Reuters Health) - Soaring prices and out-of-pocket costs for EpiPens to treat severe allergic reactions haven't halted a surge in the number of children and adults filling prescriptions for the devices, a U.S. study suggests.

Researchers who analyzed prescriptions filled by privately insured people found that out-of-pocket spending for EpiPens climbed 535% from 2007 to 2014. During that same period, annual EpiPen prescriptions almost tripled.

But the number of prescriptions filled by each patient barely changed. This suggests patients' costs rose due to price increases, not because people started using more EpiPens, said lead author Dr. Kao-Ping Chua, a public health researcher at the University of Chicago.

"For EpiPen in particular, failing to fill a prescription due to cost could mean the difference between life or death when serious allergic reactions occur - this is why Mylan's EpiPen price hikes are so ethically troublesome," Chua said by email.

Generic drugmaker Mylan obtained the rights to sell EpiPen in 2007. Since then, Mylan has increased the list price from $94 to $609, researchers reported March 27 online in JAMA Internal Medicine.

In part due to patient outcry over rising out-of-pocket spending, Mylan released a $300 generic EpiPen in December, the researchers note.

More recently, health insurance giant Cigna dropped coverage of the branded $600 EpiPens and drugstore chain CVS started selling a generic epinephrine injector from Lineage Therapeutics, Inc. for $110.

For the study, researchers examined data on people who receive private health insurance through more than 100 employers nationwide. They looked at co-payments, co-insurance, deductibles and total out-of-pocket spending.

From 2007 to 2014, patients' average annual out-of-pocket spending on EpiPen rose from about $34 to $75.

The proportion of patients with out-of-pocket costs of at least $100 climbed from 4% to 18% during the study period, while the share of patients with costs of at least $200 increased from 0.1% to almost 5%.

In October, Mylan agreed to pay the U.S. government $465 million after it was accused of falsely classifying the brand EpiPen as a generic medicine to reduce the size of the rebates it owed. Drugmakers pay rebates to Medicaid but they pay less money if a drug is a generic. Mylan didn't admit wrongdoing.

Mylan avoided paying $226 million in rebates on only two formulations of EpiPen from 2012 through 2016, according to a separate study in JAMA Internal Medicine. That suggests the total amount Mylan owed the government may far exceed what the company agreed to pay in the settlement, the authors write.

"High spending on prescription drugs on the part of public payors like Medicaid means that they have less to spend on coverage for other health benefits such as doctor's visits, hospitalizations and long-term care," said lead study author Dr. Jing Luo of Harvard Medical School and Brigham and Women's Hospital in Boston.

"They must either reduce covered healthcare services or reduce the number of eligible members and kick people off Medicaid," Luo said by email.

A Mylan spokesperson declined to comment on the Medicaid study beyond a statement made at the time of the settlement (here: http://bit.ly/2dLhDCA).

In January, Mylan said that about 90% of consumers who got its brand or generic EpiPen had an out-of-pocket cost of less than $50. During the same timeframe last year, 80% of patients paid less than $50 out-of-pocket, the company said.

SOURCE: http://bit.ly/2nYjF7y and http://bit.ly/2nYc2xL

JAMA Intern Med 2017.

[nyguy]

The problem is the US pricing system is so opaque that it's impossible to tell who actually pays what for a drug.

First off, you get a list price. Larger pharmacy benefit managers will negotiate a discount on most brands or exclude them from coverage. Then you have pharmacy benefit manager rebates. They don't tell you what these are. Depending on your plan the PBM can keep all, some, or none of the amount (in large group plans they'll give the entire amount to the company responsible for the plan). When you're trying to pay your deductible off you might pay the $250 in entirety for a thirty day supply of drug xyz even though your PBM/company only spent $125 due to the PBM rebate.

Then we have coupons and copay cards. Example: I fill 90 days of drug ABC. Price my insurer tells me is is $750 (again, not realistic), my copay for a preferred brand is just short of $75. CVS at retail automatically applies a coupon that brings it barely above $30 for my out-of-pocket. Then you have the same thing with Auvi-Q: $9,000 price for four injectors, $90 copay, PSKW rebates the $90 on behalf of Kaléo Pharma, I'm zero out of pocket.

And for totally different price scales, Lineage (Adrenaclick) and Kaléo (Auvi-Q) basically do the same thing: Adrenaclick will rebate via copay card to $10 ($110 retail minus $100 max benefit) for people who don't have insurance, Kaléo will provide Auvi-Q for $0 for people with commercial insurance who refuses to cover it or don't have commercial insurance but make less than $100K/yr via patient assistance program.

I think the biggest problem is that the Lineage Adrenaclick, Mylan EpiPen/generic EpiPen, and Auvi-Q are all not A/B rated with each other so Adrenaclick cannot be substituted for a prescription written as EpiPen, even without the "dispense as written" box being filled.. Some states permit A/B rating substitution at pharmacist discretion, but even in the states that do it 90%+ of pharmacies (under a chain) the pharmacist won't exercise that right. Even before the whole EpiPen pricing outrage my local one store pharmacy substituted Adrenaclick for an Epipen prescription at their discretion (I think it was availability to fill, not copay, but I'm not sure).

Allergies have increasingly grown in public consciousness which is why people will fill EpiPens: Nobody wants to risk the worst case scenario. At the same time PBMs have incentive to limit costs. I think the market has normalized at this point and the market will largely correct itself:

1) Anybody with medicare/medicaid will probably be covered for the generic Epi regardless.

2) People without those and without commercial insurance are likely more price conscious, and with the whole EpiPen scandal doctors will likely know and promote the Adrenaclick for a cheaper fill for these patients.

3) People on commercial insurance will likely either have EpiPen covered or at least the generic version. Generic doesn't have the same copay offer but the price is much more reasonable under copays.

4) People with permissive insurance will find Auvi-Q covered at a ridiculous price to insurer, if they don't cover it under commercial insurance Kaléo will fill for free at direct delivery. They'll capture a smaller portion of the market due to less brand awareness. (I think this strategy will bite Kaléo in the a** in the end as there's no real incentive for PBMs to continue to fill Kaléo if they will fill scrips for free if they blacklist it, but that's another topic).

/endrant, sorry for the brain dump.