Health and Science

EpiPen prescriptions jumped last month even as outrage grew over price hikes

Daniel Acker | Bloomberg | Getty Images

Mylan caught a ton of heat in August over the skyrocketing price of its lifesaving EpiPen anti-allergy injection device to more than $600. But its sales that month might have been even hotter.

Prescriptions for EpiPens in August were sharply higher than in the previous three Augusts, according to data from Athenahealth, the cloud-based health-care services company.

Because of back-to-school purchases, August annually is the biggest-selling month for the EpiPen devices, with 70 percent of the prescriptions going to people 18 and younger.

Athenahealth's data shows that in the first three weeks of August there was a 32 percent increase in prescriptions for EpiPens compared to the first three weeks of August 2015.

It also shows that the first three weeks of last month accounted for 21 percent of all EpiPen prescriptions year-to-date, compared to 17 percent of all prescriptions for the same time frame last year.

And so far this year, prescriptions of EpiPens overall are up 13 percent compared to the same time period last year, according to Athenahealth.

Athenahealth's data is based on prescriptions by more than 1,100 health providers.

"As the prices have increased, the demand has increased as well, which is exactly the opposite of what you'd expect to see given the laws of price and demand," said Josh Gray, vice president of research at Athenahealth.

"I really think this just reinforces the observation that the growth of EpiPens [prescriptions] has been seemingly imperious to their price increases," Gray said.

"This is not an area where parents want to cut corners for their kids, or adults for themselves," Gray said. "In this moment of decision, physicians are not going to be particularly price sensitive... they're going to keep their patients just as safe as they can."

"I can't see evidence that they're taking price into account, at least as it affects overall volume figures."

Mylan's EpiPen prescription volume may be being helped, at least somewhat, this year by the absence of a leading competing product, Sanofi's Auvi-Q, from the market.

Auvi-Q was subject to a mass recall last October after a series of suspected malfunctions in delivering the correct dosage of the drug epinephrine, which counters the effects of the potentially fatal allergic reaction anaphylaxis.

Sanofi said earlier this year it was dropping plans to re-enter the market.

However, Athenahealth's data shows that prescriptions for EpiPens in 2015 as of the third week of August — when Auvi-Q was still on the market — were 6 percent higher than the same period in 2014.

Public outrage over the cost of EpiPens exploded last month after consumers and elected officials highlighted the fact that the auto-injectors have increased in retail price more than 400 percent in recent years. Democratic presidential nominee Hillary Clinton called Mylan's actions "just the latest troubling example of a company taking advantage of its consumers," and said she was "calling on Mylan to immediately reduce the price of EpiPens."

On Wednesday, the Senate's Permanent Subcommittee on Investigations said it was opening a preliminary inquiry into Mylan's pricing and competition practices.

EpiPens were selling for $100 per two-pack back in 2008.

As the full retail price for the device rose to more than $600, Mylan CEO Heather Bresch's annual compensation has soared more than 700 percent, to $19 million. And Bresch, whose father is U.S. Sen. Joe Manchin, D.-W.Va., last year orchestrated a re-incorporation for Mylan in the Netherlands. That so-called inversion will net Mylan a nice break from U.S. taxes despite the fact that its main offices are in Pennsylvania.

A number of members of Congress have asked Bresch to explain EpiPen's price increases. Minnesota's attorney general is also investigating the product's price.

While some customers are paying the full price, there are coupons that can lower the cost to $300 for qualified customers. Others have much of the cost covered by their insurance plans.

But doctors routinely urge people with allergies and parents of kids with allergies to have multiple sets of EpiPens, for the home, school, car and workplace. That can increase out-of-pocket costs for customers.

"Come early 2017," when her existing stock of auto-injectors will pass their expiration date, "I can be laying out close to $2,000," said Janet Friscia, 44, a New Jersey resident and demand manager at PwC, whose 9-year-old daughter Samantha suffers from allergies.

"I normally get four, one for school, one for her backpack, one for home at all times, and one in my purse," Friscia said.

She said the ever-rising cost of EpiPens "makes me angry."

"I took my kids back to visit their old day care, and the manager there, she said, 'There is a child here with a severe egg allergy, and there is not an EpiPen there because her parents cannot afford to buy a second twin-pack,' " Friscia recalled.

"A child could be on the floor, not able to breathe, in a matter of seconds, because someone can't afford the $600," she said.

Mylan has "a monopoly on the market and they are price-gouging and people could die from this because parents have to make this awful choice on whether they can buy the drug," Friscia said. "They've got people by the throat, because they have no other choice."

Mylan does not release details about how much it costs to make an EpiPen, which relies on a decades-old technology. But outside experts have said it costs no more than $30 per device, and possibly much less. The dosage of epinephrine itself reportedly costs just about $1 per device.

Brasch, Mylan's CEO, has defended the price hikes as being the product of a system in which a number of third-parties, including wholesalers, pharmacies and pharmacy-benefit managers, get paid out of the ultimate sale of EpiPens to consumers.

She also has blamed the increases on the fact that more Americans in recent years have become covered by high-deductible health insurance plans, which require them to pay more out-of-pocket for drugs and health services.

Mylan last week said it will roll out a generic version of the product that will sell for $300, which is still triple the price from less than a decade ago for brand-name EpiPens.

The company a week before that had responded to growing outrage by increasing the financial help that many EpiPen customers can get to lower their out-of-pocket cost for the device.

Mylan operates an EpiPens4Schools program, which since 2012 has distributed more than 700,000 EpiPens to schools nationwide for free. Schools also can buy the devices at a discounted price.

On Tuesday, United States senators Richard Blumenthal, D.-Conn., and Amy Klobuchar, D.-Minn., asked the Federal Trade Commission to investigate whether Mylan violated antitrust law with the program by putting restrictions on schools participating in the EpiPen program by barring them from buying a competing product. New York's attorney general on the same day opened his own probe into that question.

Mylan said its program "continues to adhere to all applicable laws and regulations," and noted that there are not purchase requirements to participate in the program, "nor have there ever been to receive free EpiPen Auto-Injectors."

The company added, however, that "Previously, schools who wished to purchase EpiPen Auto-Injectors beyond those they were eligible to receive free under the program could elect to do so at a certain discount level with a limited purchase restriction, but such restriction no longer remains."