Anaphylactic sticker shock
Author gouged by makers of life-saving injectable
A couple of months ago, I had an allergic reaction that was severe but short of full-blown anaphylaxis, which can lead to shock and, if it goes untreated, death.
As a result, I became one of those consumers gouged by the pharmaceutical industry. When I picked up my prescription for a package of two potentially life-saving EpiPen Auto-Injectors, it rang up for $630.
The whole thing started while I was tossing a Frisbee with some friends in a grassy field at Chico State. I stepped on a bee barefoot and got stung. I kept playing for a couple of minutes, then stopped to pull out the stinger and noticed a thin red rash starting at my already-swollen foot and shooting up my leg. It didn’t look good. Feeling flushed, I left the field and walked toward my truck, parked in a lot on Nord Avenue.
Halfway there, white hives had formed on my arms and legs and my face felt heavy. Not only was it swollen, as I saw in the reflection of my cellphone, but I also looked 30 years older. The creases around my mouth and on my forehead were bizarrely exaggerated. The rest of my body was rapidly turning lobster-red; every inch of skin itched intensely.
Calling 911 was not an option. I couldn’t afford to ride in an ambulance and Enloe Medical Center was just blocks away. So, I got in my truck and started driving, now feeling like I was breathing out of a straw. This was really serious, I thought as I turned onto North Cedar Street toward the hospital. Then the engine sputtered, because my truck was out of gas.
The first-line medication for an anaphylactic reaction is epinephrine. According to information provided by Denise Kratzer, a battalion chief with Butte County EMS, it’s used to treat allergic reactions caused by insect bites or stings, foods and medications, and works by relaxing the muscles of airways and tightening blood vessels.
Butte County EMS keeps epinephrine in vials or pre-filled syringes, depending on the concentration, and the first responders use it fairly often. Last month, the agency answered roughly 2,000 emergency calls and administered epinephrine 91 times.
Drawing epinephrine into a syringe and injecting it is easy, at least for medical personnel, said Dr. Anton Dotson of Chico’s Allergy Associates.
“I know how to fill syringes,” he said. “But a normal civilian who’s stung by a hornet, they’re nervous, having a hard time breathing. Everything that people can fumble is worse when they’re having a reaction—how much to draw up, what dose, where to inject it.”
Enter the EpiPen, produced by pharmaceutical company Mylan. It’s relatively foolproof, automatically delivering a measured dose of epinephrine when pressed into the thigh. It’s a trusted brand name among allergists and other health care professionals.
“It’s the easiest to use and the best device on the market,” Dotson said.
It’s also the only device on the market. Last year, Sanofi, producer of EpiPen’s main competitor, issued a total recall of its product, the Auvi-Q, due to inaccurate dosages, according to the U.S. Food and Drug Administration.
In 2007, when Mylan purchased the EpiPen trademark, two of the devices cost $57, according to Connecture, a health insurance technology and data analytics company. Mylan then launched an awareness campaign on childhood allergies and steadily raised the price; the company’s annual profits on EpiPen now exceed $1 billion, according to Mylan’s website.
Janet Balbutin, owner of Chico Pharmacy, said that the cost is up by nearly 500 percent since 2010 and that her customers usually will decline to buy EpiPens when they see the price tag.
“It’s the poorest people who are paying for it,” she said. “They’re afraid for their children; they’re scared to death of not having it.”
As for my story, my truck sprang back to life on North Cedar Street, ran on fumes for the last couple of blocks and died just as I coasted into a parking spot outside Enloe’s Emergency Department.
The woman at the front desk gave me one look and put me at the front of the line. Within minutes, I was in a hospital bed with vital sensors on my chest, an IV in my arm and a nasal cannula helping me breathe.
Hospital staff asked me if I’d ever been stung by a bee; I told them that I’d been stung six or seven times over the past few years, but this had never happened. Well, it will from now on, a nurse said. The reaction, my body overresponding to the bee’s venom, will be worse if I’m stung in the future.
The IV contained a cocktail of antihistamines and steroids and, over the next hour, my skin turned from red to splotchy to normal, and my face looked more or less all right. I was written a prescription for EpiPens and sent home.
On the way out, the nurse advised me against playing sports barefoot.
A kit of epinephrine, which comes with a vial of medication, syringe and gauze, costs $10, Balbutin said. When the medication expires, it’s $2.50 to refill the vial. She recommends that patients ask their doctor to prescribe them such a kit, rather than pay for an EpiPen.
“The company, Mylan, thinks they can get away with it right now,” she said. “[Pharmacists] don’t have an answer.”
Julie Knell, a representative for Mylan, responded to the CN&R’s request for an interview with a prepared statement.
“Mylan has worked tirelessly … advocating for increased anaphylaxis awareness, preparedness and access to treatment for those living with potentially life-threatening (severe) allergies,” it reads. “Given the unpredictable and life-threatening nature of anaphylaxis, nothing is more costly than failed or no treatment.”
Mylan’s statement attributes the price changes to the health care insurance landscape. “An increasing number of families are enrolled in high deductible health plans, and deductible amounts continue to rise. This shift … has presented new challenges for consumers, and they are bearing more of the cost.” The company doesn’t control final retail prices, it continues, and offers coupons that eliminate co-pays for some patients.
The people who get gouged, Dotson said, are either uninsured or haven’t met the yearly deductible on their health plan, like me. When I begrudgingly bought my EpiPens, I learned they weren’t a one-time expense. The medication expires after 12 months and must be refilled.