Outrage over major price hikes in the cost of the EpiPen, a lifesaving device used to reverse serious allergic reactions, has prompted New Jersey lawmakers to call for further scrutiny of this particular medicine and a legislative review of the rising prices of a number of critical drugs.
The issue became a major focus at meetings of both the Assembly and Senate health committees on Thursday that revealed a number of questions about insurance coverage of EpiPens, regulations regarding their use in schools, and the wider issue of rising drug prices. Lawmakers advanced two bills designed to reduce the cost of this particular product and pledged to hold hearings on the escalating costs of certain life-saving medicines.
Lawmakers called the price increase of the EpiPen “unconscionable” and “price gouging” after hearing from a variety of experts about how many patients are now forced to pay as much as $600 for a pair of EpiPens, an emergency epinephrine injection that cost less than $75 five years ago. Pharmacists said the problem is particularly challenging for parents who are now stocking up on the devices to help protect allergic children at home and in school.
Doctors and pharmacists also warned that the EpiPen is not the only drug whose cost has shot up in recent years. The price of some insulin treatments have escalated 300 percent; certain antibiotics have jumped from $10 to $650 per lot; and new medicines to treat hepatitis-C are so costly few can actually afford to get cured, they testified.
“The EpiPen is just one part of a much larger story,” said Anthony Reznik, of the Independent Pharmacy Alliance.
The EpiPen “is a lifesaving drug, so it’s got a lot of attention” with its price hike, explained Dr. Lauren Carruth, a family physician who has worked in Atlantic and Mercer counties. “But it is the tip of the iceberg for what I am seeing every day in my office.”
While research shows drug prices in general have crept up by low double digits for several years, major spikes in the cost of medicines like the EpiPen have drawn particular criticism. The device is manufactured by Mylan, a Pennsylvania-based drug maker, which currently has little competition. It involves a spring-loaded injection system, designed to easily calibrate an accurate dose of epinephrine, a powerful drug that can reverse allergic reactions that result in anaphylaxis – a terrifying condition that can involve convulsions, cramping, fainting, heart palpitations, and difficulty breathing.
Assemblyman Herb Conaway, (D-Gloucester), a physician who chairs the health committee, noted that EpiPens involve about a dollar’s worth of epinephrine and packaging that costs less than $30 to produce. “What we have, I think many would find, is an irresponsible actor in the marketplace who has put families at risk,” Conaway said. “I think we’re witnessing, I’ll use the term price gouging,” he continued, “and it really has people’s backs up against the wall.”
Ruth Marietta, president of the NJ Pharmacists Association who works in the business, described a disabled man who came into her store to pick up an EpiPen for his disabled daughter. But the price was prohibitive. The pharmacy arranged some discounts, but it still took the man several months to save up enough to purchase the device, she said.
To help lessen this burden, the Assembly health committee passed a pair of legislative proposals Thursday designed to help families secure less costly options. One bill (A3910) would require pharmacist to notify patients if there is a cheaper option to the EpiPen and, if they are interested, follow up with their physician to switch the prescription. The other measure (ACR199) encourages the federal Food and Drug Administration to expedite its review of EpiPen alternatives.
“We’ll try to do what we are able as a legislature to address this public health concern,” Conaway said. “The supply chain is something we need to look at too,” he added, but said that would wait for another day.
Sen. Joseph Vitale, (D-Middlesex), leader of the Senate health committee, agreed there was a need to explore the issue of drug pricing further. As for Mylan, Vitale said he had invited them to testify at Thursday’s hearing, but they declined to respond. “Profit is one thing, but this is extreme,” he said of the company.
“Today it’s an EpiPen. Tomorrow it’s another drug your family needs,” added Sen. Richard Codey, (D-Essex). “It is price gouging at it’s worst. And it is why the U.S. government needs to do something,” he added. “This is unconscionable.” (Congress has pledged to hold hearings into the EpiPen cost crisis.)
Carruth, the family physician, said a regular syringe filled with epinephrine will also work, but it can be challenging for untrained family members or friends to manage these in an emergency. There is an alternative auto-injector, called Adrenaclick, that sells for less than one-third of the current EpiPen price, she said, but it isn’t well known by doctors or patients. “I had never heard of it before this,” Carruth said.
Pharmacists also cautioned that, while EpiPen is covered by many insurance plans, coverage does not always extend to alternative treatments. They urged lawmakers to review this issue as part of a larger investigation into the high cost of some drugs.
Dominic Vizzoni, who owns pharmacies in Trenton and Allentown, said most Medicaid or Medicare patients who come to his pharmacies are covered for the device, save for a small co-pay. But not all commercial plans offer such complete coverage, he said. He described one father who came in with two kids, both of whom needed a pack of two EpiPens each to take to school. The total cost was $1,200 – for the copay alone, he said.
“In this particular case they came up with the money – I don’t know how, but they did it,” he said. “But it’s scary because there are people out there who can’t afford it.”
EpiPen maker Mylan did not respond to a request for comment, but a press release posted to their website said that – with insurance coverage, discounts, and coupons now offered by the company – nearly 80 percent of patients got the device for no cost. It also said more than 700,000 pens had been distributed free, including to nearly half the schools in the United States.
But experts agreed that coupons and other discounts only go so far. Higher prices for drugs drive up the cost of hospital care, health insurance, and other systems; so, even if patients get a discount, society ends up paying more. The high cost “adds to the increase in healthcare (costs) in this country. The driver of healthcare costs these days is not hospitals or doctors, it’s drug companies,” Codey agreed.
The hearings also raised questions concerning school policy. According to Department of Education regulations that took effect last fall, all schools must maintain a stock of auto-injection epinephrine shots in a safe and accessible place and must train specific individuals to administer the dose to students, if needed. Conaway said he writes standing prescriptions to two South Jersey schools to meet this mandate.
The mandate does not call for parents to supply the drug if their children are allergic, but the pharmacist said many families are being told they must provide two new pens for each susceptible student every school year. That struck Assemblywoman Nancy Munoz, (R-Bergen), as overkill, given the state requirement to stock schools with the pens.
Senator Robert Singer, (R-Ocean), also wondered if it was necessary to dispose of all the devices at the end of the school year. “What’s the real life of an EpiPen?” Singer asked.