By Matt Smith
WebMD Health News
Reviewed by Hansa D. Bhargava, MD
Aug. 22, 2016 -- The rising cost of a life-saving allergy drug dispenser is raising eyebrows at the pharmacy counter and on Capitol Hill.
The price of the EpiPen, which treats severe allergic reactions, has gone up sixfold in recent years. It can cost as much as $700 for a pack of two auto-injectors before insurance. Parents of children with food allergies in particular are up in arms, and the increase has drawn the ire of some federal lawmakers.
WebMD asked experts to explain the price increases and what those who need EpiPens can do.
What's an EpiPen, and how is it used?
EpiPen is the trade name for the most common type of epinephrine auto-injector. It's a spring-loaded, pre-filled syringe that delivers a single dose of epinephrine. The drug, a man-made version of adrenaline, a hormone made by our bodies, is used to counter a potentially life-threatening allergic reaction known as anaphylaxis. It's designed to be jabbed into the outside of your thigh, which triggers the spring and sends the needle into your leg.
Auto-injectors like the EpiPen are much faster and simpler than drawing a dose of epinephrine out of a vial into a syringe and injecting it into a vein. Their speed and convenience has made them popular among people with life-threatening allergies.
"That's been proven to be a much more dependable source of treatment, especially for children," says Bob Lanier, MD, the executive medical director of the American College of Asthma, Allergy and Immunology.
How expensive is it?
Epinephrine, commonly known as adrenaline, is cheap. The dose in an auto-injector can cost as little as $1, Lanier says. It's the mechanism that's expensive, largely because it has to meet tough government standards for reliability. Like a parachute, "It has to work every time," he says.
But the price of the EpiPen has gone up sharply in the past several years. In 2008, pharmacists' cost for a two-pack of EpiPens was less than $100. As of May, it was running just over $600, according to the Elsevier Gold Standard Drug Database, which tracks U.S. wholesale drug prices. Retail prices can top $700 or more before discounts or insurance reimbursements, according to DrugRx.com, a website that compiles consumer prices.
That's steep enough for one set. But many people find themselves having to buy several sets of auto-injectors a year to keep at schools or at relatives' or caregivers' homes. And the EpiPen has a 1-year expiration date, which means that becomes an annual cost.
That's where the real issues come in," Lanier says. "You're taking about thousands of dollars a year on an indefinite basis."
Why did they get so expensive?
The pharmaceutical company Mylan, which bought the EpiPen from Merck in 2007, says more people are buying higher-deductible health plans, meaning they're paying more for drugs that may have been covered before.
"With changes in the healthcare insurance landscape, an increasing number of people and families are enrolled in high-deductible health plans, and deductible amounts continue to rise," Mylan says in a statement to WebMD. "This shift, along with other insurance landscape changes, has presented new challenges for consumers, and they are bearing more of the cost."
There's something to that, Lanier says. The Affordable Care Act has resulted in many new high-deductible insurance policies being sold on the Exchanges the landmark health-insurance law set up.
Nicole Smith, whose son's experience with food allergies has led her to become an advocate for children with similar issues, says that doesn't account for the drastic increases. She says Mylan has turned the EpiPen into a "cash cow," jacking up prices while it enjoys a near-monopoly position, and is calling for a federal probe of the company's price increases.
"I would like to see them publicly brought to task for this," Smith says.
Mylan told CBS News last week the EpiPen's price "has changed over time to better reflect important product features and the value the product provides," saying "we've made a significant investment to support the device over the past years."
The advocacy group Food Allergy Research & Education points out that Medicaid, the federal health-insurance program for the poor, covers epinephrine in all 50 states. But with no serious competition, people with those high-deductible insurance plans end up paying retail price, says James Baker, MD, FARE's chief medical officer and CEO. The drug's manufacturer, insurers, and others should justify the increased cost, he says.
Can I buy an alternative to the EpiPen?
While EpiPen is the biggest player in the market, there's a version called Adrenaclick, which delivers the same drug with a different injector. A two-pack sells for between $140 and about $375, according to GoodRx.
Another auto-injection device, known as Auvi-Q, was pulled off the market in October 2015 after regulators found problems with it delivering an inaccurate dose of epinephrine -- or failing to inject the drug entirely. Auvi-Q's manufacturer is expected to resubmit the device for approval, Lanier says.
Then there's the old-fashioned way: A syringe filled with the proper dose of epinephrine. It's not as simple as the EpiPen, but it still does the job and remains the typical method in other countries.
"It's not a difference between a life-saving drug and nothing," Lanier says. "They have the difference between an auto-injector and an epinephrine syringe."
I'd rather stick with the EpiPen. Can I get a break on the price?
Mylan promotes what it calls a "$0 Copay" card, which provides a discount of up to $100 on a two-pack of EpiPens at the pharmacy. The company says more than 80% of the people who got EpiPens through their insurance company paid nothing in 2015.
The company also offers a program to help low-income, uninsured patients get EpiPens. And since 2012, Mylan says it has distributed more than 650,000 auto-injectors to U.S. schools, many of which are now required to keep epinephrine auto-injectors on hand.
Will this change anytime soon?
FARE says it's trying to get additional manufacturers to jump in and bring the price down, Baker says. But he says, "None of these efforts will provide immediate relief."
Lanier says it typically takes three competing products in a market to start bringing prices down. Short of that additional competition, there are two other things that might help curb the costs. Regulators could approve new epinephrine products like an oral dose, or add epinephrine to the list of preventive medicines that insurance plans have to cover under the ACA.
But whether that would require them to cover the auto-injection mechanism? "That's the $64,000 question," he says.
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SOURCES: Bob Lanier, MD, executive medical director, American College of Asthma, Allergy and Immunology. American Academy of Asthma, Allergy and Immunology.Mylan, press statement. News release, Food Allergy Research & Education. James Baker, MD, chief medical officer and CEO, Food Allergy Research & Education. Elsevier Clinical Solutions' Gold Standard Drug Database. DrugRx.com. CBS News. Nicole Smith, parent.
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