EpiPen cost increase hits home in Sonoma County

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When Santa Rosa resident Liz Liddiard-Griffin learned earlier this year she would need to pay nearly $550 for a single EpiPen two-pack, she had three words for the staff at her local drugstore.

“Are you kidding?”

They were not.

Liddiard-Griffin has regularly purchased the EpiPen, an injector that can save those suffering a life-threatening allergic reaction, for years because her son, Michal, is extremely allergic to both nuts and shellfish. Now 18, Michal was 3 months old when an allergic reaction first sent him to the hospital, and he was prescribed EpiPens not long after that.

Liddiard-Griffin had become accustomed to stocking three injectors: One for her, one for her son and one for the office at her son’s school. So the prospect of paying hundreds more dollars than she had ever paid for EpiPens before irritated and frustrated her.

“I was like, ‘Why? What’s going on?’ Obviously, I couldn’t say no,” she recalled in an interview this week.

In the end, Liddiard-Griffin had little choice but to pay full price for the device, which is used to quickly inject a dose of epinephrine, a hormone that can counter life-threatening allergic reactions. She had to pay out of pocket because she had not yet reached her family’s $1,500 deductible.

And she was not alone. Liddiard-Griffin was among numerous residents across the country to express irritation with Mylan, the pharmaceutical company under fire this week for raising EpiPen’s list price to about $600 for a two-pack this year, up from about $100 when it acquired the device in 2007.

Simultaneously, Mylan’s current chief executive Heather Bresch saw her total compensation jump from more than $2.4 million in 2007 to more than $18.9 million in 2015, according to filings with the U.S. Securities and Exchange Commission. Bresch — the daughter of Sen. Joe Manchin, D-West Virginia — also went from being chief operating officer to president to CEO in that time.

The EpiPen price increase has drawn strong condemnation from members of Congress, including Sen. Chuck Grassley, R-Iowa, the chairman of the Senate Judiciary Committee. Grassley sent a letter Monday to Bresch asking the company to explain its analyses for determining the price of EpiPen, citing concern “that the substantial price increase could limit access to a much-needed medication.”

Mylan’s actions also drew sharply negative reactions from Sen. Amy Klobuchar, D-Minnesota — whose daughter needs EpiPen — and Democratic presidential nominee Hillary Clinton, among others. The public furor came months after another pharmaceutical executive, Martin Shkreli, appeared before Congress amid uproar about his company’s decision to dramatically raise the cost of another key drug.

Bowing to the intense backlash over EpiPen costs, Mylan announced Thursday it would provide “immediate relief” by offering a savings card for up to $300 to patients facing steep out-of-pocket costs for the devices. The company also said it would double eligibility for its patient assistance program so a four-member family making up to $97,200 would not pay anything for EpiPens.

But Grassley remained unswayed by Mylan’s move, saying in statement Thursday the company did not appear to change the price paid by Medicare, Medicaid and insurance companies and that when assistance cards are offered by drug companies, “it’s usually not clear how many patients benefit.” The senator said he still expected a written response to his Monday letter.

North Coast Rep. Mike Thompson, who said he heard directly from a constituent about the high EpiPen cost at an event this week, also remained critical in an interview Thursday morning.

“As we’ve seen with Mylan, they certainly should be ashamed, but there’s no indication that they’re trying to change their ways,” Thompson said. “I think Congress needs to be vigilant. We need to look at ways to provide cheaper drugs, we need to make sure that we have the consumer’s well-being in mind and we need to be cognizant of these prices.”

Part of the issue is a lack of competition. A generic competitor to EpiPen was rejected by the Food and Drug Administration and a nongeneric alternative was recalled for potentially delivering incorrect dosages of epinephrine.

That has left Mylan with a near-monopoly, although EpiPen still is not the only epinephrine injector available. Another option is Adrenaclick, which works differently than EpiPen: It requires the removal of two caps to administer, while EpiPen only uses one. Adrenaclick can cost more than $100 less than EpiPen, according to LowestMed.com, which aims to help consumers to find lower prices on pharmaceuticals.

Cat Bessing, a former Santa Rosa resident who now lives in Solano County, said she is prescribed a generic version of Adrenaclick. She said she regularly suffers from severe allergic reactions and uses multiple injectors a year.

“I know my allergist wouldn’t let me have something substandard,” Bessing said. “What makes me crazy is things like this with the EpiPen, where someone is making money because of this.”

Maria Petrick, an allergist with Santa Rosa-based FamilyCare Allergy & Asthma, was concerned to hear of reports from some patients unable to afford their EpiPen prescriptions — prior to Mylan’s Thursday announcement. Yet Petrick also said Adrenaclick was a more complicated mechanism.

“In a panic situation, when you have to have something that you know how to do, if the mechanism is different, then there’s a risk that you’re not going to get the medication,” Petrick said. “You need something that’s quick and easy to use, and the EpiPen is.”

Mylan, for its part, has attempted to deflect blame for the EpiPen controversy onto the broader health care system itself.

In a company statement Thursday, Bresch said Mylan saw the burden placed on patients by “continued, rising insurance premiums” and admitted patients deserved “increased price transparency and affordable care, particularly as the system shifts significant costs to them.” The company statement later suggested the Affordable Care Act was driving higher costs for patients.

While health care costs have increased compared to earlier decades, the Affordable Care Act should not necessarily raise the bar for out-of-pocket insurance costs, said Stuart Schweitzer, a professor at the UCLA Fielding School of Public Health.

“Obamacare is not driving up premiums. That’s absolutely wrong,” Schweitzer said. “And the whole point of universal coverage, which Obamacare is aiming at, is to lower premiums, because we’re going to have 18-year olds who are really healthy buying premiums just as you and I are, and that’s going to bring the cost of care down.”

In any case, Liddiard- Griffin remained skeptical even after hearing about Mylan’s announcement Thursday, and she was unsure how any of it would affect her moving forward.

“How dare they do that to even begin with? ... EpiPen is not like an aspirin,” Liddiard-Griffin said. “It’s a lifeline.”

She said she hoped the company would have to answer for its actions in a public forum.

You can reach Staff Writer J.D. Morris at 707-521-5337 or jd.morris@pressdemocrat.com. On Twitter @thejdmorris.

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