Health

Recently, Cigna announced that they are no longer covering Mylan’s EpiPen, CVS Pharmacy announced a low cost generic alternative, Adrenaclick, an epinephrine device with a price point at 1/6 the cost of an EpiPen, and Auvi-Q announced that they are returning to market in February.

Last week, I appeared on FOX Business to discuss all of this, as well as the impact that the Trump Presidency might have on drug pricing. In the segment, we also discussed the market makers and middle men that help to secure Mylan’s revenue model.

Then a funny thing happened on the way to my inbox. A PR reached out to me from Mylan Pharmaceuticals. FOX Business has been trying to reach them to no avail. I’ve been a voice in this space for over a decade.  What struck me is that the day before, Auvi-Q announced that it was returning to the market on Valentine’s Day.

What had once been a monopoly suddenly wasn’t, and from Cigna to CVS Pharmacy to Adrenaclick to Auvi-Q, Mylan now faces some serious competition. They can no longer hide.

So in order to give Mylan’s PR people an idea of what consumers are saying, I reached out to our online community for feedback. Perhaps the most heart wrenching  was from a mom who just lost her son over Thanksgiving. Two EpiPen devices were not enough to save his life. It was too late.

Here are some honest and heartfelt messages from consumers (we did not include those laced with profanity), not just for Mylan, but for all who are providing life-saving devices to our families:

• They failed the people they were supposed to help. ~Jennifer
• They victimized already suffering families. ~Kelly
• I just checked prices via my insurance unit d healthcare and all my options seen 370 per two pack or more. I see no change from last year. I would like them to lower their price will all insurance programs to a reasonable price considering I have to buy 4 2 packs (2 kids and 2 schools) ~Colleen
• I’ll be going to CVS for their generic, priced at 1/6 the price of the actual Epipen today, and will never again support Mylan as long as Heather Bresch is CEO. ~Cindy
• One question: Why haven’t they dropped the price? We all know the answer to that question is greed, but I’d be interested to hear their answer anyway. ~Joe
• Too little too late. Maybe they should think next time before gouging families for life saving medications. We will never see that money that we were overcharged. Shameful! ~Barbara
• Your corporate culture of arrogance is finally catching up with you.. ~Amanda
• Ask them where we sign up for refunds for past overpriced purchases? Last year my out of pocket was $1300 with the coupons and those expire this month. ~Jen
• I’m on an insane High ded plan aka catastrophy insurance but pay premiums like it’s a real plan. LOL. $8K family deductible. Epis aren’t my only issue here but for something you HAVE to buy EVERY year and multiple packs to cover school, off site after school, dads house, etc. it’s insane. I’ve had to split packs at school and pray they grab someone else’s if they need a second pop. ~Jen
• Please ask how they arrive at pricing, both for brand and generic, as well as pediatric and adult dose. I am referring specifically to the insanity we spoke of a couple weeks ago,whereby my insurance company paid the most for the pediatric generic epinephrine. ~Valerie
• Today’s consumers are not as stupid as you take them to be. ~Nina
• Please tell them what goes around…comes around. Do the right thing when it comes to pricing in relation to profits. Care about the individuals who are dependent on your products for their health—especially the children. ~Kerry
• How can we work together for the greater good, which will increase your bottom line when you give value to people.
• That’s if they care about people ~Liz
• Apologies would be a good start. ~Alison
• No thanks. ~Amy
• That it’s too little too late and we are moving on to other devices that we can afford, from companies that did not play with our children’s lives for profit. ~Susie
• It’s hard to decide what to tell them. They betrayed the trust of the consumers who need life saving medication. I am struggling to gather questions or thoughts on what to tell them. ~Pamela
• Epinephrine is a life saving medication. Deliberately making it into a business money maker took this critical medication out of the hands of those that needed immediate access to it. Trust lost is hard to regain. ~ Ann Marie
• Please tell Mylan that the voice of the consumer has been heard. ~Jayne
• I just yesterday tried to fill my EpiPen prescription at CVS and even WITH the $300 coupon, my out of pocket cost would’ve still been over $300.
• I have commercial health insurance with United Healthcare. Luckily I was at CVS and was able to get the generic alternative for $110 (for two pens.) ~Jennifer
• That they should be ashamed for price gouging food allergy families. For taking advantage of our fears of losing our children to anaphylaxis. For not coming up with a way to truly make epinephrine available and affordable to everyone who needs one prior to being “caught.” For not being the leader of taking on the PBMs to help fix healthcare. For doing nothing to bring a more updated, innovative epinephrine device to food allergy families that is smaller and more user friendly. They chose profits over our children and we are mad. ~Elizabeth
• They don’t want a cure for us. Then they’d lose their “baby”. Everything is a show. They took advantage of a vulnerable group though, and so the cat is out of the bag that they have no ethics. Yes, they are for profit. But they abused us and everyone knows it! Their image is almost beyond repair. And now that there are multiple options available, including Auvi-Q which totally blows them out of the water, they know they are going to sink. ~Jillian
• The Edwards brothers are putting them to shame. The irony is their Auvi-Q brand is going to end up being all about TRUST. Something Mylan took for granted. That is very difficult to gain back. They have to work for it. Actions speak louder than words. They have proven that they only care about lining their pockets. Probably the only thing they can do to even begin to salvage any kind of respect and trust is for Heather Bresch to step down, and appoint someone that really cares. ~Jill
• That now that there are more choices on the market, we will CHOOSE to go with companies that have better business ethics and actually see their customers as real people and not just profit centers. ~Marina
• They should refund the difference between what they charged and what Audi-Q is charging directly to the families that paid their outrageous prices to save their children. ~Paul
• Ask them how much they have paid to pharmacy benefits managers in deals and kickbacks to ensure that EpiPen (or its generic) is the only EAI listed or the preferred EAI listed on national/large formularies. Ask them to outline how’s these deals are negotiated. Ask to see the contracts. ~Leading pediatric allergist
• I am so angry and saddened that it wasn’t enough to make a profit (as they should), but making a huge profit and then an even BIGGER profit was the modus operandi here, all at the expense of families who just want to keep their allergic loved ones alive! Heather Bresch’s greed preyed upon families’ fears and that is not ok. We’re not talking about a drug like Viagra (which is covered by Medicare BTW…). Epinpeherine is the only thing that will stop death for those in anaphylaxis. ~Elizabeth
• I’d like them to feel the pain of what I’ve been through as a food allergy parent for 18 years. And the financial burden they’ve put on families who are already struggling enough. And tell them I’m glad Auvi-Q is back, hard as Mylan might’ve tried to get rid of them. ~Donna
• We were forced to miss house/car payments, not buy groceries, not even be able to afford the expensive allergen safe foods for our daughter.
• I want to know -why do they value their $ over so many people’s lives? Why instead of taking a pay cut did they let so many employees go ? ? ? Right before Christmas?
• (Obviously more questions than things to tell them. Personally, if I had the chance to say anything to them it wouldn’t be too nice )
• You are cruel, selfish bastards. I hope you make peace with God someday, because until you do you, you have a very hot seat next to the devil.
• You are in a position that is paid to help people, instead you paid yourselves to willingly put lives at risk. Day after day you woke up and made that choice. ~Jennie

And one more for good measure:

I have 2 daughters who require an epi-pen due to peanut allergies. My older daughter uses the adult dosage, while my younger daughter requires the pediatric, or ‘junior’ version.

During the course of my discussion with my mail in pharmacy regarding the price difference between adult and junior pens, as well as the LACK of a difference in consumer price between the generic and name brand (both of which are manufactured by Mylan, by the way) I was told that my pharmacy’s cost for the epi-pen, epi-pen Jr and the generic equivalents are as follows:

BRAND:
Epi-pen $613.48
Epi-pen Jr. $613.48

GENERIC:
Adult $297
Junior $782.51

No, that is not a typo. The generic junior costs my pharmacy almost $500 more AND is, in fact more than the brand version.

My cost as the consumer is considerably less, however, I am still paying more for my younger daughter than my older one, and my cost is the same, whether I choose the generic or the name brand.

Clearly Mylan has failed to live up to their promise of a less expensive generic version and is continuing their very shady business practice. Despite numerous attempts, I was unable to speak with anyone at Mylan who could provide an answer as to the price discrepancy.

Please feel free to contact me if you have any questions. I am absolutely livid!

Any questions?

KALÉO announced today that AUVI-Q will be available by prescription nationwide on February 14, 2017. This is a story we have been following since twin brothers, Eric and Evan Edwards, first launched the device several years ago. The company has invested considerable time, meeting with the food allergy community and the pharmacy benefit managers, also known as “PBMs.” The PBMs are the middle men or market makers who decide what products go into which plans and onto which pharmacy shelves. Three PBMs determine the market for the entire pharmaceutical industry. As you can imagine, negotiating with these market makers is difficult given the lack of transparency in the industry.

As a result, Kaléo brings Auvi-Q to market under a new system in order to address the needs and concerns of the food allergy community.

• More than 200 million Americans with commercial insurance, including those with high-deductible plans, will be able to obtain AUVI-Q for $0 out- of-pocket.
• AUVI-Q will be available free of charge to patients with a household income of less than $100,000 who do not have government or commercial insurance.
• The cash price for AUVI-Q is $360, and will be available to those patients without government or commercial insurance.

Kaléo, a privately-held pharmaceutical company, today announced the AUVI-Q® (epinephrine injection, USP) Auto-injector will be available by prescription starting February 14th, and announced AUVI-Q AffordAbility, a first-of-its-kind access program for AUVI-Q. Through this new program, patients with commercial insurance, even those with high-deductible plans, will have an out-of-pocket cost of $0. For patients who do not have government or commercial insurance, and have a household income of less than $100,000, AUVI-Q will be available free of charge. In addition, the cash price for AUVI-Q is $360 and will be available to those patients without government or commercial insurance. Each AUVI-Q prescription includes two Auto-injectors and one Trainer for AUVI-Q.

“We met with patients and physicians and listened to the very real challenges in the current healthcare environment with obtaining access to affordable medicines,” said Spencer Williamson, President and CEO of kaléo. “As a result, starting February 14, for more than 200 million Americans with commercial insurance, including those with high-deductible plans, the out-of-pocket cost for AUVI-Q will be $0.”

AUVI-Q is a FDA-approved prescription medicine used to treat life-threatening allergic reactions, including anaphylaxis, in people who are at risk for or have a history of serious allergic reactions. It is an epinephrine auto-injector with innovative features such as voice instructions that help guide a user with step-by- step instructions through the epinephrine delivery process and an automatic retractable needle system, a first for epinephrine auto-injectors, that injects the epinephrine and retracts the needle back into the device within seconds.

“We know how important it is that severely allergic patients have an epinephrine auto-injector that can be with them at all times and used correctly, even without training, during a panic-stricken allergic emergency,” said Eric Edwards M.D., Ph.D, Vice President of Product Strategy at kaléo. “We are excited to make AUVI-Q, an epinephrine auto-injector with innovative features, available for millions of patients living with severe, life-threatening allergies.”

AUVI-Q AffordAbility is a first-of-its-kind program and commitment for AUVI-Q, designed to provide affordable access to this potentially life-saving epinephrine auto-injector for eligible patients. This new program removes potential and previously experienced insurance barriers, restrictions and delays, even for those commercially-insured patients with high-deductible plans. AUVI-Q will also be available via a direct delivery service, that can ensure the best expiration dating for AUVI-Q. For live assistance in filling an AUVI-Q prescription, any patient, physician or pharmacist will be able to call 1-877-30-AUVI-Q.

Identical twin brothers, Eric and Evan Edwards, the inventors of AUVI-Q, grew up with life-threatening allergies. They know what it is like to live in fear of that life-or- death moment, both as patients and parents of food-allergic children. Their goal was to develop an epinephrine auto-injector that contained innovative features, such as a voice instruction system that helps guide patients and caregivers step-by- step through the injection process. Eric and Evan Edwards believe and trust in AUVI-Q, not only for themselves, but also for their children and other families who may have to depend on it to administer epinephrine during an allergic emergency.

To learn more about AUVI-Q, please visit www.auvi-q.com.

About AUVI-Q

AUVI-Q (epinephrine injection, USP) Auto-injector is a prescription medicine used to treat life-threatening allergic reactions, including anaphylaxis, in people who are at risk for or who have a history of serious allergic reactions. AUVI-Q contains epinephrine, a well-established, first-line treatment for severe, life-threatening allergic reactions that occur as a result of exposure to allergens including food such as peanuts, tree nuts, fish, shellfish, dairy, eggs, soy and wheat; insect stings or bites; latex and medication, among other allergens and causes.

AUVI-Q is the only compact epinephrine auto-injector with a voice instruction system that helps guide patients and caregivers step-by-step through the injection process, and a needle that automatically retracts following administration. In anaphylaxis emergencies, it is often individuals without medical training who need to step in and deliver potentially life-saving epinephrine. AUVI-Q was designed through careful analysis of the situations where epinephrine auto-injectors are used and with significant input from the allergy community that relies on it incorporating Human Factors Engineering (HFE). HFE is about designing products or systems that are easy to operate and, most importantly, support correct use, with the goal to remove the potential for error. For more information visit www.auvi-q.com.

Today, a life threatening allergic reaction sends someone to the emergency room once every three minutes. It’s costing our economy $25 billion dollars a year—in drug costs, lost productivity, special dietary needs and more.

And it’s costing us over $600 every time we purchase an EpiPen.

That last statistic is what launched the food allergy world into action. Mylan jacked up the price of EpiPens so many times in eight years that families could no longer afford them. So parents made a lot of noise, and in August 2016, we launched #epigate which brought attention to the price-gouging. Mylan’s share price fell 24%.

But even before that started, there was another mom of four, witnessing all of this. She held a huge role, not as an advocate, but as the head of CVS Pharmacy. Like me and millions of others, her youngest suffers from life-threatening allergies.  And like all of us, she saw an opportunity to do better.

As the head of CVS Pharmacy, Helena Foulkes has done an incredible job leading CVS Pharmacy, as first seen in the company’s move to remove tobacco products from their stores.  She also led her company’s effort to work with Impax, the maker of the generic version of epinephrine, Adrenaclick, to bring an epinephrine product to market at a price point that families can afford.

When the #epigate conversations started in the summer of 2016, Adrenaclick cost about $200. Still high and without a robust supply chain, it was not the right fit.  Consumers and pharmacies shared concerns that if demand hit, there were questions about whether or not the the company making Adrenaclick would be able to provide the life-saving devices to the millions who need them.

Through the second half of last year, CVS worked with Impax to ensure that it could. And yesterday, CVS announced that they would carry the Adrenaclick at $109.99—the same price that an EpiPen cost over 8 years ago. A full 1/6 of the price of an EpiPen today.

The headlines took over the food allergy world. They had been heard not only by one of the largest pharmacy chains, but they had also been heard by a mother of four inside of the company who personally understands how food allergies impact millions of lives.  And she demonstrated remarkable leadership.

Food allergies don’t care where we work or who we voted for. They don’t discriminate in the lives that they take, and it is on all of us who are part of this to not only find a solution but also to do everything we can to protect the millions of Americans now dealing with this condition.

Adrenaclick is a different device. Education will be required to teach consumers about it, and training is always required with any life-saving epinephrine device. Is it perfect? No, but none of them are yet. And the more choices that we have on the market, the better the devices will become, and the more lives we can save.

Think back to that first cell phone? Imagine if we’d stopped there. Competition is in the best interest of consumers. Competition yields the best product.

When I spoke with CVS today, they said, “We believe in giving consumers informed choice.” That is something that I have said countless times myself in my work in the food industry.

As Americans, our democracy is built on informed choice – from what we choose in the pharmacy, to what we choose in the grocery store, to what clothes or cars we buy.

It’s no surprise that this first move comes from CVS. If you remember, they were the first to remove tobacco products from their stores. Why? Their mission is to help people on their path to better health.

They will be helping millions of Americans with food allergies, by offering a device at a price point that many can afford.

Mylan’s monopoly has put too many lives at risk. They’ve priced consumers out of securing the devices needed to protect their loved ones.  CVS stepped in to help.

Americans deserve an informed choice, a basket of products from which to choose when it comes to protecting their loved ones with food allergies.

Monopolies only benefit the monopolist.

As CVS moves to provide more options and choice, it opens up the category to other players, too. And with Auvi-Q coming back on the market in 2017, that can’t happen soon enough.

Thank you, CVS, for opening the door to other products. May the best auto-injector win.

In the last few months, we have heard from families around the country, but perhaps some of the most poignant messages we’ve received are from families in West Virginia. They have watched this story unfold firsthand. As you can imagine, some of the conversations around dinner tables in West Virginia are tough.

So when we received this amazing and heart-felt letter from a father and paramedic in West Virginia eloquently voicing his concern with Heather Bresch and Mylan for their EpiPen price gouging practices, sharing the personal nature of the political issue, we felt it was really important to share.

We are so grateful for all who are speaking out on this issue, as it brings an awareness not only to the skyrocketing price of EpiPens but also to the number of families around the country on both sides of the aisle now struggling with this condition.

Hello Robyn,

As a West Virginia native, born in Wheeling and currently living in Morgantown, WV, I would like to voice my opinion on the EpiPen marketed by Mylan Pharmaceuticals.

As you know Mylan is located here in Morgantown, is well-known as being one of the largest employers in this area and has recently come under fire for the scandal associated with the exorbitant price hikes of their proprietary “EpiPen.”

This issue is near and dear to my heart. I was a paramedic for 30 yrs in this state and know the outcome of untreated anaphylactic shock. This can result from many allergen exposures such as bee stings, shellfish and closest to me, peanuts. My youngest daughter is allergic to peanuts, as are a growing number of children across America each year. As a family, we have had to purchase EpiPens for years to keep close in case of accidental exposure when she was away from home and I always carried a back up with my first aid gear. All schools require parents of children with life-threatening allergies to provide them with an EpiPen, a copy of the prescription and training on how to administer it each school year in cases of emergency. This means that we had to purchase not one EpiPen but multiple devices that could be kept at school when my daughter was younger, one for her to carry with her as she got older and one to keep at home. Another factor to consider with EpiPens is that they have an expiration date, so whether they are used or not, they must be discarded within this timeframe and new ones purchased to be kept everywhere they are needed. We had decent insurance at the time but even with our copay, the devices could be costly when considering the need for purchasing multiples every year, and that was before the recent price hike.

When the facts are broken down, the EpiPen is nothing more than a glorified delivery system for an extremely inexpensive drug that in many cases has the potential to save lives. While I can fully understand the need for companies to occasionally increase prices for certain products based on higher costs required to make and market the product, I cannot fathom the need for a 400% increase in recent years of a device whose main component is a drug that costs around ONE DOLLAR per device. What astounds me even further is the true reason behind the price hike… The increased profit will undoubtedly not be funneled to the workers on the production lines or the creation of more jobs to produce the product or even charitable contributions to find cures for any number of diseases, but as I understand it, at the root of this entire scheme is greed on the behalf of one person at the top of the food chain at this company. The following is an excerpt from an online CNBC article: “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.”

In my humble opinion as a caregiver and father, this act is nothing less than criminal. The substantial price increase causes a huge hardship for families with no other option but to purchase the EpiPen and knowing that the sole reason behind this act is the sheer greed and selfishness of one person, Heather Bresch, is simply unforgivable.

I wholeheartedly believe that Heather Bresch of Mylan Pharmaceuticals is taking every advantage of cornering the market with her monopoly of this product and the recent news reports of her mother, Gayle Manchin, spearheading an effort to encourage schools to purchase epinephrine auto injectors is despicable. I sincerely hope that no lives are lost as a result of families not being able to afford a dollar’s worth of epinephrine, all over a little bit of money.

Mike Katona