By Henry Ehrlich
Competition is supposed to be the consumer’s friend, but in the life-saving auto-injector market, the field is dominated by EpiPen, with Auvi-Q making some inroads. As those families with high insurance deductibles have learned, the out-of-pocket costs of these must-have devices are sky high. Prices of $4-500 and up of the two brands are set, in all likelihood, according to what the market will bear in relation to one another. The Chevy costs as much as the Cadillac. This doesn’t meet the standard of price fixing for purposes of antitrust enforcement. But as the drug industry continues to consolidate, competition disappears from the marketplace as if by what Adam Smith used to call an invisible hand. In the wake of generic drug maker Teva abandoning its takeover bid for Mylan, EpiPen’s maker, only to purchase Allergan, Bloomberg reported:
More mergers could lead to higher generic-drug prices, a trend that’s already getting attention in Washington and among consumer groups. The National Community Pharmacists Association surveyed about 700 members and found earlier this year that virtually all pharmacists have experienced a “large upswing” in the cost of buying generic drugs in the prior six months. About 80 percent of respondents experienced price spikes at least 26 times — equivalent to once a week.
So how are the middle-people, the health insurance companies, responding to this. Just because they can negotiate prices for drugs doesn’t mean they are immune from price rises. I was talking to our friend and contributor Jessica Martin the other day. Her insurance company had bailed on both Epi and Auvi in favor of the lower-priced generic for Adrenaclick, which has been on the market since 2013 without making much noise as the other two duke it out. But is this a good trend for food-allergy families? Will it provide a healthy shot in the thigh to competition and lower prices? I asked her to write about her family’s experience and as you would expect from a PhD neuroscientist, she came up with some provocative answers that put a range of contemporary health care issues under a microscope.
We have rehearsed as far as possible. It’s similar to how the EpiPen works. Pull off two caps and press and hold in outer thigh. It didn’t come with a trainer (a big concern for if we leave our sonIan with someone less familiar). We have rehearsed with a trainer at the allergist’s office – yes. My main concern is for others who may need to respond with this device if we are not there. The fact that his school nurse (who is in charge of 6 different schools) had not seen this device for any of her students and has so far not trained on it is a concern. We are going to fork over the money this year upcoming school year for the EpiPen or Auvi-Q, and press really hard for the Adrenaclick trainer once all of our EpiPens are expired. I was the first to let our nurse know of this potential coming for next school year. We have Kaiser Permanente insurance, which is a major provider for our area/west coast. This is new as of Jan. 2015. Previously EpiPens were well covered (I believe we had a $40 copay for the pair. Last I checked it was close to $500 for the pair). My guess is they are going to start seeing a bunch of Adrenaclicks. I’m conflicted… I really like Auvi Q and our school nurse relayed to us on several occasions that teachers/staff feel so much more comfortable and more likely to inject (I’ll add that our school’s nurse is awesome! Wish she were there more than part of the day two days a week. That’s a whole other topic for discussion).
Thanks, Jessica. Always love your point of view. You’ve given me plenty to think about. Like, how many injectors will teachers have to train with? Will an unfamiliar injector cause dangerous hesitation by new users? Kaiser is a trendsetter by virtue of its size in the California market.