Heather Bresch, Mylan and EpiPens

[Mama_Zappa]

So I tried to pick up a pair of EpiPens yesterday for my son. He flat out forgot to do so before his trip to Europe, so I hope he doesn’t lose any fights with stealth peanuts.

Only, it turns out our insurance does not cover them. We’ve run into that sporadically in the past, but we were able to shell out the cost - 50-100 bucks or whatever (other times, insurance policies covered it). This time, however, it was 700 dollars.

Now, I don’t know how insurance companies get off on saying this is not medically necessary, but that’s not the point right now.

As it turns out, Mylan has been advertising the product heavily while jacking the price up insanely since they acquired the product.

AND THEY"RE BLAMING THE STICKER SHOCK ON INSURANCE:

@Mylan in a statement to Gizmodo

“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. This shift, along with other insurance landscape changes, has presented new challenges for consumers, and they are bearing more of the cost. This change to the industry is not an easy challenge to address, but we recognize the need and are committed to working with customers and payers to find solutions to meet the needs of the patients and families we serve.”

@another piece of Mylan propaganda

“As the health insurance environment has evolved, driven by the implementation of the Affordable Care Act, patients and families enrolled in high deductible health insurance plans, who are uninsured, or who pay cash at the pharmacy, have faced higher costs for their medicine.”

[Quote=Heather Bresch saying it’s lovely that we’re gouging Americans to pay for other countries to have these drugs]

“We do subsidize the rest of the world… and as a country we’ve made a conscious decision to do that,” Bresch said. “And I think the world’s a better place for it.”

[/quote]

So in other words, they are saying that “if it weren’t for that pesky insurance, you wouldn’t even notice our jacked up prices - your insurance would cover it, but then everyone’s premiums would go up next year, but you won’t tie that to OUR gouging so that’s OK. Really, it’s Obamacare that makes you notice it, otherwise we’d be able to keep sneaking the prices up”.

There is, effectively, no alternative product. For a while there was none; now there is Adrenaclick which is barely known in the market. Mylan has a “generous” discount program which will save Some customers 300 dollars, but even so, they’re gouging insurance, and the program does not cover anyone with ANY kind of government plan (Medicare, TriCare and so on).

Oh, and Heather dear, no, no we did NOT make a conscious decision to pay for everyone else’s drugs. Lobbyists did. They are not human.

How is this kind of behavior not covered under antitrust legislation?

[mhendo]

You’re a little late to the party. This story has been all over the news for the past six weeks or so, and we had a 4-page Pit thread about it.

[gnoitall]

@Mama_Zappa

How is this kind of behavior not covered under antitrust legislation?

This comes back to a long-standing question: When does “legitimately gained” monopoly status rise to the level of being inherently anti-competitive?

“Legitimately gained” means that a company played fair according to the current legal anti-trust rule set and won, driving all competition into non-existence or ineffectuality.

Some have argued that results are an acceptable measure of anticompetitive monopoly: that there is no such thing as a legitimate “clean and fair” monopoly; that if you “won” you must have broken the spirit of the antitrust law, if not the letter, and you need to be punished or broken up or something.

Of course, since we’re a nation of law, we probably can’t do that. But lawsuits like US v. Microsoft means that things that anti-competitive action can be designated unlawful in an anti-trust sense “after the fact” (by the findings of a lawsuit).

In other words, Mylan may not have done anything that could be strictly and obviously considered illegal in the anti-competition sense, but could be decided later in an anti-trust prosecution to have been violations of specific provisions of the law. Because in some types of law, it’s not obvious at a glance that certain actions violate the law, just because the law doesn’t directly address that behavior.

ETA: Mylan has competition, even. But their direct-to-doctor marketing has been so good that MDs generally don’t prescribe epinephrine auto-injectors generically, so usually the scrip has to be filled with the named product: Epipen. Is really effective marketing against the law?

[Damuri_Ajashi]

@gnoitall

ETA: Mylan has competition, even. But their direct-to-doctor marketing has been so good that MDs generally don’t prescribe epinephrine auto-injectors generically, so usually the scrip has to be filled with the named product: Epipen. Is really effective marketing against the law?

It depends. Does the really effective marketing include golf outings, dinner at Palm and blow jobs in the examination rooms?

[John_Mace]

Not to worry-- president Trump will fix this! No one cares more about allergies than he does.

PS: Could you son have bought some in Europe? I think they are much cheaper over there, no?

[mhendo]

@John_Mace

PS: Could you son have bought some in Europe? I think they are much cheaper over there, no?

That was going to be my question, too. The answer, it turns out, is yes:

While the manufacturer, Mylan NV, says it takes home about $274, in the U.K. a similar pair of injectors costs the state-funded National Health Service 53 pounds ($69). The numbers highlight the stark differences in the way drugs are priced in the U.S. and Britain, where the government negotiates with pharmaceutical companies to limit costs.

<snip>

The cost for two EpiPens ranges from less than $100 in France to just over $200 in Germany.

It’s not clear to me, however, whether you can walk in off the street, as a visitor, and pay these prices in the pharmacy, or if such prices are only available when you go through the national health systems (like Britain’s NHS), which negotiate prices with the manufacturers, and are generally only available to citizens.

[Mama_Zappa]

@mhendo

That was going to be my question, too. The answer, it turns out, is yes:It’s not clear to me, however, whether you can walk in off the street, as a visitor, and pay these prices in the pharmacy, or if such prices are only available when you go through the national health systems (like Britain’s NHS), which negotiate prices with the manufacturers, and are generally only available to citizens.

Yeah - I actually thought about suggesting he do so when he gets back to London, except

1. he may not have time
2. as noted, he might not be able to, and
3. He has literally never used the ones we’ve had in the past.

I don’t know what the percentage is of units used versus units sold but I imagine it’s fairly small - hopefully most people are able to avoid allergens most of the time. So you shell out 700 bucks for something you will most likely never use. And you have to shell it out again, and again, and again.

[Grim_Render]

Its possible to just ring a pharmacy in London and ask. They got pharmacies in the airports too.

[John_Mace]

Perhaps a knowledgeable British poster can advise.

[Baron_Greenback]

@John_Mace

Perhaps a knowledgeable British poster can advise.

Lloyds Pharmacy (one of the larger chains) sells a single EpiPen for £49.99 and a pair for £89.99

EpiPen | LloydsPharmacy Online Doctor UK

The instore price won’t be much different.

[Nava]

@mhendo

That was going to be my question, too. The answer, it turns out, is yes:It’s not clear to me, however, whether you can walk in off the street, as a visitor, and pay these prices in the pharmacy, or if such prices are only available when you go through the national health systems (like Britain’s NHS), which negotiate prices with the manufacturers, and are generally only available to citizens.

It is available to anybody with one caveat: if it’s OTC, it’s available to anybody who asks for one, and if it requires a script (epinephrine autoinjectors do in most countries) you have to get one. What will be needed in this second case is the trickier part. People who have illnesses such as diabetes or serious allergies are asked to travel with a medical information file from their doctor (medical history highlights, scripts, etc), but generally getting a foreign script accepted will require getting a new, local one.

There are some locations where there is an extra discount applicable only to some people (for example, to pensioners, either by age or disability), but even there, the basic price will be negotiated.

[Tom_Tildrum]

@Mama_Zappa

How is this kind of behavior not covered under antitrust legislation?

Other manufacturers have proposed generic versions, but the FDA has rejected them.

[BigT]

@Tom_Tildrum

Other manufacturers have proposed generic versions, but the FDA has rejected them.

This is what doesnt make sense to me. The autoinjector itself is not under patent anymore. There was an improvement that is, but the original isn’t. And if it passed the FDA in the 70s, it should pass now.

There’s no need to create a new autoinjector, and the old one should be generically available. So why are they being rejected?

[gnoitall]

@BigT

This is what doesnt make sense to me. The autoinjector itself is not under patent anymore. There was an improvement that is, but the original isn’t. And if it passed the FDA in the 70s, it should pass now.

There’s no need to create a new autoinjector, and the old one should be generically available. So why are they being rejected?

Unspecified “major deficiencies”, in the case of the Teva product. “Human factor” and dosage regulation issues in the Adamis one.

The “Human Factors” angle is interesting. Mylan astroturfed a “citizen’s petition” to the FDA about epinephrine auto-injector generics, citing “objective concerns” that any generic device would be dangerous and inadequate in the intended emergency scenario because it would use a different sequence of operations than the market dominating device, EpiPen. In other words, “Everyone knows how to use an EpiPen, and since those generics are so different, people could die if an emergency responder had to fumble around figuring out how to used one of those generic ones.”

The petition got rejected, but it seems that maybe the idea affected the assessment of the Adamis application.

[Mama_Zappa]

Mylan is introducing the interesting concept of selling a generic version itself, for about half the price.

Which sounds pretty bizarre, but:

1. They won’t offer the 300 dollar price support on that one, so
2. the net price (for the uninsured) will be about the same

In fact the generic may cost some people more since it doesn’t have the price support. So Mylan gets to sorta almost look like they’re helping, without actually costing them anything.