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Epipen price hike is a problem for us all

I was recently working in the emergency department when a middle school student was brought in by ambulance after having experienced difficulty breathing and swelling of the throat while at school. Fortunately, the school nurse administered epinephrine via an Epipen prior to the ambulance arriving at the school, and the patient was breathing normally by the time they arrived to the ED. There could have been fatal consequences if the administration of the epinephrine was delayed and/or if the school or patient's family could not afford it and did not fill the prescription.

There has been much discussion about the significant increase in price of this life-saving medication. Epinephrine is a medication prescribed to patients who have life-threatening allergies to various environmental triggers including peanuts and bee stings. Such reactions are a manifestation of a process known as anaphylaxis. Some people who have anaphylactic allergies may have difficulty breathing if they are exposed to those allergic triggers and may ultimately die if epinephrine is not given in a timely manner.

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The price of an injectable form of epinephrine ("Epipen," sometimes called adrenaline) has increased several hundred fold over the past several years. This price increase is rather unusual for medications like this one that has been available for decades in a generic form. While the medication is available in a generic form, the delivery method (the "pen" of Epipen) is the part that often has a patent. Such patents prevent the manufacture of generic delivery devices for epinephrine.

Even if you don't have a diagnosis of anaphylaxis and/or don't have a prescription for an Epipen, this price increase affects us all. Many of us are covered by health insurance policies that pay at least a portion of the price for the medications that we use as policy holders. The increase in price of medications often requires insurers to pay more money for medications. In some instances, insurers pass on some of this increased cost to us, the policy holders, in the form of higher insurance premiums and deductibles for all beneficiaries regardless of whether we individually fill a prescription for an Epipen or have a diagnosis of anaphylaxis.

Epipens are not the first medication that has had a significant price increase — it is just one of the most recent. Following the initial outcry and associated media coverage, a few municipalities will try to combat this on a local level while our national leaders hold hearings about this most recent medication price increase. Some hospitals are introducing creative yet simple work-arounds including dispensing relatively inexpensive syringes in a package with the medication (e.g. the University of Utah). While such creativity is laudable, the main goal of all such efforts should be to set up systems that prevent such significant medication price increases from occurring.

There are several things you can do to help address this situation. If you are personally impacted by such medication price increases, you should contact your primary care provider to explore whether there are more affordable options or discount programs available for you. All of us can support local, state and federal legislative efforts to make prescription medications more affordable for us all. One such initiative being proposed in Maryland is the Prescription Drug Affordability Initiative. Another idea being floated is working with the Food and Drug Administration and the maker of the Epipen to explore whether the shelf-life of the Epipen can be extended. Stated otherwise, this proposal would push back the expiration date on the medication so that it would not have to be refilled as often as it currently does.

At some point in our lives many of us will need to take a medication. It is therefore up to us all to work together to ensure that such significant price increases do not occur. Regardless of whether you are personally impacted, all of us can support efforts to keep this from happening again.

Dr. David E. Myles is a pediatrician and a Fellow of the American Academy of Pediatrics; his email is davidemyles@gmail.com.

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