Some Leery of EpiPen Alternatives, Despite Price Hike

UPDATE: Mylan will offer a generic version of the EpiPen with a wholesale list price of $300.

By Brenda Flanagan

“It’s offensive to me because this is essential to my daughter’s life,” said Gia Rosenblum.

Rosenblum’s 15-year-old daughter’s deathly allergic to nuts so she carries EpiPens everywhere. With one stab, the auto-injector delivers a lifesaving shot of epinephrine. But when its maker Mylan raised prices 500 percent — to $600 a two-pack — Rosenblum felt gouged.

“There’s no evidence that I’m aware of that price increase was driven by a need that they have. As far as I’m aware, it was strictly profit motive,” she said.

The EpiPen’s major competition — the Auvi-Q — got yanked off the shelf by the FDA — leaving only the Adrenaclick as a marketplace alternative. It costs less than half as much as an EpiPen, but Rosenblum’s reluctant to use it.

“To go from this to the Adrenaclick — which I understand is a little more complex, has a different mechanism of action — I wouldn’t entrust that to a teenager,” she said.

Doctors know about Adrenaclick but rarely prescribe it or its generic version.

“Most allergists feel comfortable with the EpiPen. It’s what we know. There’s nothing else that’s as well-studied so at this point that’s the one we go to, because we’re familiar with it,” said Dr. Reena Mehta, allergy and asthma specialist.

“I think physician should have a conversation with patients or with the families that need an epinephrine auto-injector about what are the options out there, what are the advantages and disadvantages to the different options? What’s the price? Physicians may not know. And that price may depend very significantly on the individual’s insurance,” said Asthma and Allergy Foundation of America President and CEO Cary Sennett.

Mylan tried to counter the criticism this week by tripling its $100 discount coupons, but the company refused to consider a price cut. It made $1.7 billion on sales of more than 3.5 million EpiPen prescriptions last year. Its CEO blamed the “broken” health care system and high deductibles.

“Had we reduced the list price, I couldn’t ensure that everyone who needs an EpiPen gets one. So we went around the system,” said Mylan CEO Heather Bresch. “Congress and the leaders of this country need to quit putting their toe in this topic and really fix it. We have an outdated and inefficient system.”

But advocates want the FDA to safely fast-track EpiPen alternatives. The agency rejected Teva’s proposed new auto-injector in February but will now allegedly expedite its re-application. Meanwhile, New Jersey lawmakers ramped up political pressure.

“Until there’s competition, you have to pound them to bring the price of that drug down. Hopefully with competition, that’ll do it without the government acting. But right now the government has to act, because there is no competition,” said Sen. Richard Codey.

Sen. Kevin O’Toole called Mylan’s EpiPen price hikes pompous and greedy and would offer tax breaks.

“So we’re asking some retailers who are worried about the public good to hold firm the price they received in 2009. Any losses they’re going to incur because of the profit gouging by Mylan, that they’ll have a tax deduction that’s going to be passed along and paid for by the state of New Jersey,” O’Toole said.

Rosenblum applauds and condemns Mylan’s monopoly pricing.

“They’re just exploiting this captive audience that doesn’t have a choice. And we’re talking about life or death, and we’re talking about mostly kids,” she said.

The Senate Health and Human Services Committee will hold hearings on the controversy next month. Families will be invited to testify. Expect fireworks.