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The EpiPen pricing scandal: A symptom of the legalized corruption embedded within the only profit oriented health care system that still exists in any developed nation on Earth.
Ross Conrad
An adrenaline auto-injector, or epinephrine auto-injector (brand name: EpiPen) is a patent-protected medical device used to inject a measured dose of adrenaline. It is often used to prevent anaphylaxis, a severe allergic reaction that can lead to death. As the body shuts down during an episode of anaphylactic shock, the adrenaline revives the patient so they have time to get to a hospital and seek medical help.
For beekeepers that are hyper-allergic to honey bee venom, the EpiPen allows them to practice the craft of beekeeping without fear of dying from an errant sting. Some beekeepers who had never historically been hyper-allergic to bee venom, have reported becoming so after they started taking medication such as beta blockers used to control heart disease that also changed the patient’s body chemistry and made them more sensitive to bee venom. Thankfully, venom hyper-sensitivity is rare and the majority of beekeepers are not deathly allergic to venom. The majority of beekeepers who keep an epinephrine auto-injector around, do so in case someone else has a severe reaction to a sting from one of their bees. As a result, beekeepers were among those who first took notice when the cost of purchasing an auto-injector, which had cost less than $100 in 2007, jumped up to over $600 by 2016.
New information on how this price increase was engineered by pharmaceutical companies has recently come to light thanks to the release of documents as part of an ongoing antitrust lawsuit in federal court. The contents of the documents reported on by journalist, Ryan Grim of the independent news outlet The Intercept, sheds insight on how through collusion and price-fixing EpiPen prices became artificially high.
People who purchased Epipens between August 24, 2011 and November 1, 2020 may be eligible to receive payment from the Pfizer settlement as reimbursement for being overcharged. Proof of claim must be postmarked on or before November 12, 2021.
The company Mylan owned the rights to distribute the EpiPen, the best selling auto-injector in America. As documents reveal, the former president and CEO of Mylan, Heather Bresch, approved a scheme to work with the former CEO of Pfizer, Ian Read, to force customers ensnared within the company’s monopoly, to have to buy two EpiPens at once, regardless of medical need. At the time, the pharmaceutical giant Pfizer made and distributed a generic auto-injector, Adrenaclick, which at about five percent of the market was the best selling generic epinephrine auto-injector on the market.
Back in 2010, the EpiPen dominated the auto-injector market with almost 95 percent of U.S. sales. As The Intercept reports, the drug company Merck owned the right to market the Epipen. In 2007, Mylan acquired the rights in a deal with Merck that allowed Mylan to own the brand name and distribute the product while manufacturing part of the delivery system, but not the medication itself. The epinephrine in the EpiPen was manufactured by King Pharmaceuticals exclusively for Mylan. According to The Intercept story, “King in 2010 announced it would be purchased by Pfizer, which was licensed to sell Adrenaclick, an EpiPen competitor, the previous year. The deal between Pfizer and Mylan led the former to withdraw its generic competitor from the market and partner with Maylan on the EpiPen, locking down a monopoly. Following the deal with Pfizer, Mylan drove the price above $600 within five years.” At the time that Adrenaclick was removed from the market it was pulling 10 percent of U.S. auto-injector sales.
When King was acquired by Pfizer, market analysts reported that Mylan was worried that the rapidly growing market share of Pfizer’s generic Adrenaclick could cut the EpiPen out of the market if the company continued to push ahead with it. Emails between the two CEOs refer to a deal in which Pfizer agreed to stop making Adrenaclick. By withdrawing the main competitor of the Epipen, Pfizer helped to create a monopoly situation that allowed Mylan to continue raising prices on the EpiPen while both firms split the profits from the overpriced version. Working with Mylan allowed Pfizer to make more money than it would have if it had driven prices down by continuing to produce and market a less expensive generic version.
Once the monopoly was in place, yearly price increases started ratcheting up the cost of the Epipen to consumers. Mylan then required customers to purchase two pens at a time. According to the documents, company executives had no medical justification for the change, but sought to generate one after the fact. Company market research concluded that since it was a matter of life and death, customers would pony up and buy two pens at a time if they were not given any other choice.
Pfizer settled a class-action suit for price fixing and is paying $345 million while denying any wrongdoing. A second federal suit against Mylan, which also denies any wrongdoing, is ongoing. For more information or to file a claim, go to EpiPenClassAction.com or call 877-221-7632. Meanwhile to lessen the impact of high EpiPen prices, Pfizer is offering pharmacy and on-line coupons and manufacturer discounts, and has even released its own generic autoinjector to help ward off competition from other potential generic versions of the drug. The Pfizer/Mylan generic pen is half the price of the EpiPen which sounds great until you realize how overpriced the EpiPen is now. Thankfully since the release of Mylan’s authorized generic for EpiPen, much more affordable generic epinephrine auto-injectors have become available and are being marketed under the brand names Symjepi and Auvi-Q.
According to Grim, the former President and CEO of Mylan, Heather Bresch is the daughter of Senator Joe Manchin, D-W.Va. During EpiPen’s dramatic price increases, Gayle Manchin, wife of Senator Manchin and Bresch’s mother, “lobbied states to require schools to stock epinephrine as the head of the National Association of State Boards of Education.” Bresch retired from Mylan last year with a 37.6 million dollar golden parachute.
Even if you’re not from West Virginia, Manchin’s name may sound familiar since it has been in the news recently. As Grim reports in The Intercept piece: “Manchin last week urged Democrats to take a ‘strategic pause’ in consideration of the party’s $3.5 trillion reconciliation package, the centerpiece of the Biden agenda. A key component of the bill would lower drug prices by allowing Medicare to negotiate directly with pharmaceutical companies. That market power would save the government and patients billions over the next decade, but perhaps even more importantly, it would give the government greater insight into how pharmaceutical executives set prices. The change could reveal the type of collusion that keeps those rates high, exposing companies to risk of regulation or prosecution.” A cynic would suggest that the threat of increased regulation or prosecution of pharmaceutical companies and their mega-donor political support is the real reason that Senator Manchin is stalling on the Democrats reconciliation package.
Ross Conrad is author of Natural Beekeeping and The Land of Milk and Honey: A History of Beekeeping in VT.
