Heather Bresch, kindly go fuck yourself with an epi-pen

[WhyNot]

@aliensshow

And to follow-up my brilliant point about this attack on a female CEO being incredibly sexist, try to imagine a Republican attacking a woman and saying she should fuck herself with something phallic, and the gallons of rage-filled tears that would flow from every media outlet and liberal from here to Pluto.

I’m absolutely certain that Martin Dickface Shkreli was invited to perform many anatomically impossible sex acts, by a great number of people.

[Broomstick]

@Tom_Tildrum

Off-topic, I have idly considered jabbing myself experimentally with one of my son’s expired pens, both to see what the injection process feels like and to see what the drug itself does, so that I have some idea what I’m doing to him if I ever have to use one for real. Everyone seems to say it’s a bad idea, though…

Read the list of possible side effects. Then think about it.

@kayaker

Personally, I’d go this route.

Five bucks, plus cost of a disposable syringe.

@muldoonthief

As I asked in the GQ thread, are you confident in your ability to load a syringe & inject yourself while undergoing anaphylaxis? Posters in that thread who have had that experience said they are not.

@Telemark

As another person who has experienced anaphylaxis, no way I could draw from a vial and inject myself with a syringe. Unless I catch it before it gets serious, I assume my wife or someone else with me will be using the Epi-Pen. People that I hike with a lot I’ve let them use the trainer pen so they won’t be using it the first time on me in an emergency.

^ This.

If you’re really in an anaphylactic emergency you’ll be losing coordination and, eventually sphincter control. Not to mention things like vomiting, blurring/tunneling vision, and you can’t breathe properly which sort of effs up things like thinking straight.

I’m not saying you couldn’t manage a vial and syringe under the circumstances, I just think it’s unlikely you’d be successful.

[Acsenray]

I’ve seen some reports that there is an alternative called Adrenaclick and that there’s a generic version of that as well.

[steatopygia]

Kayaker and others talking about buying a vial of epi and keeping it around.

Do you know the concentration? Or the dose?

Just look at the first paragraph on this page.

Epinephrine Dosage Guide + Max Dose, Adjustments - Drugs.com

[steatopygia]

Kayaker did pick the right vial in his cite

[Spice_Weasel]

@Broomstick

If you’re really in an anaphylactic emergency you’ll be losing coordination and, eventually sphincter control. Not to mention things like vomiting, blurring/tunneling vision, and you can’t breathe properly which sort of effs up things like thinking straight.

I’m not saying you couldn’t manage a vial and syringe under the circumstances, I just think it’s unlikely you’d be successful.

Sounds like a horrible experience to go through.

[Superdude]

@aliensshow

And to follow-up my brilliant point about this attack on a female CEO being incredibly sexist, try to imagine a Republican attacking a woman and saying she should fuck herself with something phallic, and the gallons of rage-filled tears that would flow from every media outlet and liberal from here to Pluto.

You may or may not believe this, but I wasn’t thinking of the epi-pen as a phallic symbol at all. I just used the epi-pen because that is what the article was about. Had it been for a product that looked like a “Georgia O’Keefe bouquet,” I would have used that, instead.

You seem to be looking for something that I wasn’t thinking. If you go back over the 15-plus years I’ve been posting here, I do not think that you will find me harboring sexist, mysogynistic thoughts.

Quite simply, it’s sexist because YOU want it to be sexist. Not because it is.

[D_Anconia]

@Folly

Only if they don’t have insurance.

So you’re saying that if they have insurance, they’ll pay more? That doesn’t sound right. Do you have a cite?

[Folly]

@D_Anconia

So you’re saying that if they have insurance, they’ll pay more? That doesn’t sound right. Do you have a cite?

Not on their website for some reason (at least that I can find), but there’s this.

Eligibility Info:

The patient must not have prescription insurance coverage through Medicaid, Medicare Part D, TriCare, a qualified health plan purchased on a state-based, partnership, or federally-facilitated Exchange, or any other public or private program or insurer.

The patient has commercial prescription drug coverage only for generic products and the patient must not have prescription insurance coverage through any state or federally funded program including, without limitation, to Medicare, Medicaid, TriCare, or Medicare Part D.

[Spice_Weasel]

Superdude, LOL @ your signature line.

Also don’t mind alienshitshow. I’ve yet to see him make a single useful contribution to any thread.

[psychobunny]

Just to clarify-for the epipen:

If you have no insurance-the company will pay if the family income is less than $97,200 via their patient assistance program. If you make more than that you are screwed.

If you have commercial insurance you can use their Epi-pen savings card which they recently increased to cover up to $300 of your copay for a double-pack (they call it a zero-copay card but if you have a high deductible you will still pay-however, most insurances have a negotiated price that is less than the retail price and if you are not using your deductible or your insurance has a different prescription deductible, this may actually cover most of the cost)

If you have governmental insurance (like Medicare or Medicaid) it depends on your particular plan.
The ones who are truly screwed are those with Medicare and no Part D prescription coverage since they will pay full price. Medicaid will most likely pay all but a nominal copay (about $1 here).

It is absolutely scandalous what they get away with in drug pricing. For example, I was pricing Nexium pills for heartburn. They have a $150 copay credit which sounds great, right? This is how it broke down:

Brand Nexium 40 mg-90 pill=$525-$150 copay=$375.
Generic esomeprazole 40 mg-90 pill=$425
OTC Nexium 22.5mg-42 pills=$23 with $5 credit at CVS (so 220 pills-110 days=$115 with $25 in CVS credit so net=$90)

Obviously, I tell my patients to buy it at CVS and use the credit for anything else they need or to apply to the next time the need to stock up.

We need national health care, although I still worry that any plan we get will not include prescription coverage which means we will still be screwed.

Let’s not even talk about how much the price of insulin has skyrocketed! Most people won’t need their epinephrine (hopefully) but people will die without insulin and some are already cutting back on their doses because of the price.

[D_Anconia]

@Folly

Not on their website for some reason (at least that I can find), but there’s this.

So do Medicare/Medicaid patients have to pay the full $608? I can’t tell, that’s why I am asking.

[psychobunny]

@D_Anconia

So do Medicare/Medicaid patients have to pay the full $608? I can’t tell, that’s why I am asking.

Medicaid-usually covers medication like this with a nominal copay (one thing Medicaid is usually pretty comprehensive about is medications).

Medicare-depends on your Part D prescription plan. Most plans will cover most of an Epipen but some will require you to pay a copay or 30% or something else-it is really variable. If you don’t have Part D you pay the entire amount except that they have a separate patient assistance program for Medicare participants in the “doughnut hole” so if you have reached that portion of your year, you may be able to get the medication from the company.

Confused yet? This is why doctor have such high overheads. It practically takes a full-time staff member to deal with this crap for my patients.

[Folly]

@D_Anconia

So do Medicare/Medicaid patients have to pay the full $608? I can’t tell, that’s why I am asking.

I doubt it, but I’m not an expert. Medicaid probably covers it and Medicare has low deductibles.

The problem comes (and my family falls into this category) is when you have private insurance with a higher deductible.

[psychobunny]

Actually, the NYT breaks it down better than I did. (Also I stand corrected-this company appears to be one of the few that does NOT have a doughnut-hole program so if you have Medicare and are in the doughnut-hole, you are indeed screwed).

[zweisamkeit]

@Typo_Negative

Wouldn’t this cost hit ambulance companies and city\county paramedic services pretty hard?

Yes, especially in states that require EMTs to carry and administer epinephrine (I’ll admit that I’m surprised that that’s not a law in all states, but whatever).

This article from the Seattle Times discusses how Washington state counties have changed over to creating and using “epi-kits” instead of epipens. Note that it was written over a year ago, too.

http://www.seattletimes.com/seattle-news/king-county-drops-epipen-for-cheaper-kit-with-same-drug/

It’s a huge money saver:

It’s primarily the expense,” she said, noting that EpiPens cost about $400 for a required two-pack, and they expire after about a year. “We were throwing an awful lot away.”

…

By contrast, the epinephrine kits put together by King County cost about $10 each. When the small vials of drug expire after a year, they’re replaced for about $2.50 apiece, Duren said.

But more importantly, use of epinephrine has risen dramatically, to the benefit of patients:

“We went from 40 EpiPens a year and now we’re at 85 uses of the kit since April,” he said. “Appropriate usage went up from 40 percent to 98 percent.”

Previously, EMTs were hesitant to use the EpiPens if the cases didn’t meet the definition of the most severe cases of anaphylactic shock — an urgently life-threatening condition, Duren said.

In addition to patients who clearly needed the drug, there were some who could have benefited but didn’t receive it, he added.

Now, in addition to the new kit, the county has adopted updated training that expands the indications for using epinephrine, the same drug used in EpiPens, to include less-severe signs of allergic reaction.

[MsRobyn]

@kayaker

I’ve never experienced anaphylaxis, but I’ve read about people who preload syringes and store them in a light-tight container.

I take several anti-hypertensive medications, and I’m a bit of a cheapskate. For less than my copay for a month’s supply of 50 mg Losartan, I can buy a bottle of 100 mg Losartan, break them approximately in half, and have a six month supply.

So, yeah. If I needed epinephrine I’d find a work-around. Acceptable (to me) risk.
ETA: cite

False equivalence. A long-term pill to manage a chronic condition isn’t the same as a drug intended to be taken in an emergent situation.

I have to inject Airman with his biweekly Humira shot. Those are in an autoinjector so it’s almost impossible to fuck up the injection. There’s just the right amount of drug in the vial, the needle is the right length for an intramuscular shot, and the whole thing has a couple of locks on it so the plunger can’t move and the needle won’t advance until I activate the thing by pushing on the plunger. Then I have to do a ten-count to make sure all of the drug has been dispensed. The whole thing is also pretty durable, plus they live in the fridge until it’s time for a shot. The Epipen autoinjector works along the same principle.

I wouldn’t trust a pre-loaded regular syringe that knocks around in my pocket, whether it’s in a container or not. There is too much opportunity for the syringe to crack and the drug to leak out, for the plunger to be forced down, causing the drug to leak out, for the needle to break, rendering the whole thing useless. That’s not something I would trust in a life-or-death situation, which anaphylaxis is. In a health care setting, where the staff are trained in proper administration, with software to pre-calculate the correct dose, and where they have proper storage for these shots, I’d be OK with that. But not in a casual setting, like the rest of the world.

That said, I’m pretty fortunate that I have excellent insurance. The copay for two Epipens is only $18. I understand that not everyone has access to good drug coverage; I didn’t for a long time. I hope Heather Bresch is forced to defend her actions to a Congressional committee on primetime television, and I hope that Obamacare will be expanded to require a zero copay for any emergent life-saving drug. Until these things happen, however, we’re stuck.

[RivkahChaya]

I first encountered the Epipen in the military. Every soldier carries one, because it’s an antidote to a particular kind of gas attack. The ones we carried in training were, as I understood, dummies (real cases, but with no needle or medicine-- they were from expired pens, I think), but soldiers in combat carry real ones.

Is it possible that the withdrawal of massive amounts of troops from the Middle East has caused the military to stop buying huge amounts of Epipens, resulting in a drop in demand?

I’m not saying this necessarily justifies the jump in cost-- I don’t know all the details of the economy of scale, and how the loss of the military as a major buyer (assuming this happened) would cause the price to go up as much as it did. That does seem like a lot, even if demand fell by half.

But if the ones the military uses can be carried around in combat soldiers’ pockets, then surely it’s possible to make them durable enough for the average citizen to carry in a purse, briefcase, or backpack? And are they different, or the exact same thing? When we had a kid at my son’s preschool who had an Epipen, it sure looked a lot like the one I carried in the military.

I guess it makes a difference when EVERY soldier has one, so if mine happens to malfunction, maybe yours will work, but still. If we all agree that the company is not especially ethical, is it possible that the idea that you need multiple pens, so you have one here, there, and everywhere, is just a ploy to get people to buy more of them?

Now, that still means you need to buy one very expensive pen, and that’s not a great solution: government subsidy would be better, if they really do need to cost that much. Charging the company under RICO price-gouging laws, or anti-monopoly laws might be another one, if the pens don’t need to be that expensive.

[Wolf333]

The auto injectors issued by the military contain atropine and 2-pam chloride, not epinephrine.

[Nava]

@RivkahChaya

Is it possible that the withdrawal of massive amounts of troops from the Middle East has caused the military to stop buying huge amounts of Epipens, resulting in a drop in demand?

I’m not saying this necessarily justifies the jump in cost-- I don’t know all the details of the economy of scale, and how the loss of the military as a major buyer (assuming this happened) would cause the price to go up as much as it did. That does seem like a lot, even if demand fell by half.

Even if the US military had completely stopped buying them, we’re talking about a product that’s made and sold globally. How have Mylan prices in Germany, Russia or South Africa behaved, to pick three markets with very different medical systems and situations?