By Tonya Winders
In the past few weeks you’ve probably seen headlines everywhere regarding the life-saving drug epinephrine, such as “EpiPen Prices Soar” and “Parents Can’t Afford Life-Saving Medication for Kids.” These headlines are alarming and rightfully capture people’s attention, but what’s overlooked is the price increases are only one piece of a puzzle that reflects a broken healthcare system.
As a patient advocate and mother of five children, including one with food allergies, I have experienced epinephrine price hikes firsthand. The EpiPen price increase by Mylan, manufacturer of the drug, is certainly frustrating for patients and families; however, the increases are also due to significant costs added on by wholesalers, retailers, pharmacy benefit managers and health insurers. Mylan’s $274 net price per EpiPen two-pack is boosted another $334 by these intermediaries, resulting in the $608 list price.
Mylan can’t just cut the price to relieve patients of the high out-of-pocket cost. Due to existing contractual agreements with pharmacy benefit managers and health insurers, the pharmaceutical company cannot reduce the price of EpiPens for at least 12-24 months. Mylan’s move to create a generic version is a step in the right direction, helping cut out-of-pocket costs for those with or without insurance – but this still does not solve the problem.
Meantime, millions of Americans are choosing government or private health insurance that features lower monthly premiums but higher yearly deductibles. Historically, people paid for their healthcare needs with fixed copayments, often $20 or $40, but in the past six years, copayment spending has dropped significantly while deductibles and other costs have risen dramatically, according to the Kaiser Family Foundation.
This is all part of a trend in healthcare that increasingly shifts the burden of medical costs onto patients. According to the Milliman Medical Index, prescription drugs now comprise 15.9% of total healthcare spending for a family of four.
No one should be forced to weigh costs to obtain life-saving medications such as epinephrine. This drug is not a luxury; it’s a lifeline.
A solution comes in three parts.
First, work with manufacturers. Patients and families most affected by price hikes across the board are typically those who either have signed up for high-deductible health plans or don’t have insurance. Manufacturers of life-saving medications should implement cost-saving programs to help these patients and families and be fully transparent on drug prices. Mylan took steps to improve EpiPen access and affordability by doubling the eligibility for patient assistance – but more needs to be done.
Next, work with the government and commercial insurers. Politicians are eager to blame Mylan for EpiPen prices, but instead they should encourage insurers to add epinephrine to the preventive drug lists. This means EpiPens would be available to all patients and families without out-of-pocket expense, regardless of the type of health insurance plan they use.
Finally, work with patients and families. Regardless of what drug and insurance companies do, or what the government does, there needs to be substantially more education on the patient level. The healthcare system and health insurance plans are extremely complicated and often hard to navigate, but with the right support and advice, parents can learn how to reduce medication costs (such as through the My EpiPen Savings Card, available at www.epipen.com/copay-offer).
Allergy & Asthma Network understands the public’s frustration. The natural instinct is to put all blame on big pharmaceutical companies like Mylan – and of course, they need to be held accountable for their pricing – but the conversation needs to be much broader than with one company. It’s with leaders of health insurance providers; it’s with the lawmakers and politicians; and it’s with patients and families. All need to work together to ensure these preventive life-saving medications are easily accessible and affordable.
Tonya Winders is President & CEO of Allergy & Asthma Network
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