In the Nick of Time

interior, Shed Aquarium in Chicago

It was a lovely spring morning. We were outside on the back porch coloring in a circus themed coloring book. Road construction was going a few streets over and a loud thumping repeated, shaking the ground as the workers broke up the concrete.

“Do you hear the elephants?” I asked.

My toddler son nodded, his eyes going wide.

“I think they are coming here! Let’s get some peanuts to feed them!”

He nodded his blonde head vigorously, grinning from ear to ear.

I ran inside and grabbed a bowl, pouring some peanuts into it. 

Then I saw the cashews. 

I’ll throw some in for fun!

I ran back outside and showed him the bowl of nuts. He grabbed a handful, as did I, and put a single cashew into his mouth. He chewed it, still smiling, and then swallowed.

Within seconds, his face turned ashen and his eyes were vacant. He stared off into nothing and would not respond to me at all. He was breathing was labored. His pulse was thready.

Then the hives appeared all over his body and he started to puke.

My son was having an anaphylactic reaction to cashews. 

He survived.

After that, I purchased an epipen and kept it on hand, just in case. 

He has had subsequent severe reactions to pistachios and kiwis. 

I say all of this to say that when I paid for the epipen the first time, it was $150 for a pair of them. Each year, I buy a new epipen to replace the expired one. Each year, the price goes up. Each year, I never have to use it I am throwing away hundreds of dollars. I hate that. Still. It’s my kid we’re talking about here. What kind of parent complains about spending money to protect their kid, right?

The other day I had a patient tell me that they just could not afford the cost of the epipen for their own son. With their high deductible plan they would be paying over $600 for a medication that they would hopefully never have to use. The price increase didn’t really matter so much to patients until the high deductible plans started to become the norm. The price difference before was picked up by insurance companies. Now, it is the patients getting stuck with it.

Yesterday, I ran across this article from the Washington Post about the soaring cost of epipens. Epipens have been around since 2004 but the cost has increased over 450%.

One quote in particular stood out to me:

Mylan (the manufacturer) itself is tight-lipped about the cost increase, saying only that it “has changed over time to better reflect the multiple, important product features and the value the product provides.”

So just how much are you willing to pay for your child’s life? For any child’s life? For a grown up’s life? Because that is what “value” is referring to here. They are holding my son’s life, your child’s life, for ransom. As for important product features…. it injects epinephrine. With a needle. 

Meanwhile, Heather Bresch, the Mylan CEO who has been with the company through the epipen price hikes, has had a substantial pay increase. Her salary in 2007 was  $2,453,456. Last year it was $18,931,068. Which makes me ask the question, how much money does she need?

Dearlilyjune asked what I thought was the greatest health crisis of our time. This is it. The sky rocketing cost of medical care. Pharmaceuticals. Imaging. Hospitalizations. Charging exorbitant amounts just because they can. There is nowhere quite like healthcare where they have you by the balls. Want to live? Want to have a good quality of life? Great! Pay some fat cat through the nose.

It is the worst in the US right now, but I figure it will be only a matter of time before this sort of thing catches on elsewhere. You cannot argue that the strategy makes money. It’s legal, even if it is unethical. 

Greed is powerful.

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124 thoughts on “In the Nick of Time

  1. It is completely unconscionable, and there is no reason for it. It was approved in 1987 — it is a generic product, and while there have been modification over time, they aren’t terribly extensive.

    I was thinking this morning while reading an article about this, that it seems silly that individual parents must buy one for their child to be kept at their school. As you say, they are rarely used. It would make sense for schools to coordinate with parents of affected kids to maintain a handful of them. (I know the regulatory expert in me is screaming but this is a fixed dose product. There should be a way of making this idea workable.)

    So glad your son was OK!

    Liked by 4 people

  2. What the pharmaceutical companies are doing should be criminal. It’s ridiculous. The insurance companies are next in line. Take, take, take. Policy could be written, but those who write policy are in bed with the drug makers and insurers. Yet again, the only people who benefit are those who don’t need help. Healthcare in the US is in a sad state of affairs.

    Liked by 4 people

  3. A pair of pens cost around $120 here. Hives, swollen throat, puking and disorientation… they don’t appear to be enough to warrant a prescription. The pens are only available as prescribed medication, and are therefore heavily subsidised. Same problem, different rules.

    Liked by 1 person

  4. I’m a Benefits Manager for my employer and I’m always trying to educate employees on these various things. They are always concerned about the rising cost in their prescription drug plan but don’t take note of these kinds of things that affect our rates. I’ve never had a high-deductible health plan because I work in government, but it takes education. One thing to note is that employees can use a coupon card to pay no co-pay for most drugs (like Epipen) in their high deductible plan until they hit their limit. The coupon cards would make the employer believe that the employee paid the true cost of their drugs and thereby having them hit their deductible quicker instead of paying $600 for the drug out of pocket. Here’s a coupon card: https://www.activatethecard.com/epipen/?sitelink=co-pay%20savings%20card&utm_medium=cpc&utm_source=google&utm_campaign=epipen%20-%20branded&utm_term=epipen%20coupon&gclid=CLCU5KqI3c4CFYmeNwodOB8LdQ&gclsrc=ds

    Liked by 3 people

  5. We, too, are Epi-pen people. It’s like having insurance. You hope you never have to use it but it’s a must have just in case. I’m wondering now how long past the expiration date we can use the ones we have.

    Liked by 3 people

  6. A year later, I’m still paying off the cost of birthing my daughter. Bear in mind that I made regular advanced payments during the pregnancy toward the labor (which felt like putting my own child on layaway), but suffered a slew of complications that kept me in the hospital for a week. By the time I’ve “paid her off,” she will have cost $11,000 out of pocket. I have my work-required, high-deductible insurance.

    All of which is to say, THANK YOU, beyond measure, for addressing this!

    Liked by 2 people

  7. Even worse, in some cases, are the ignorant people blaming “Obamacare” for the unaffordability of drugs. Sorry, people: the Affordable Care Act isn’t responsible for the greed of pharmaceutical companies – it’s the CEOs of said companies, and has been for some time…

    Liked by 4 people

  8. Before I read some of Greenwald’s books, I thought this was just all unstoppable greed. It is gutwrenching to know that it’s totally stoppable, and that (bipartisan) elected officials choose not to stop it because we individuals don’t lobby like drug companies can and do.

    I shared a related post on LinkedIn this morning. This enrages me more than I can express. I can afford this medicine for my son, but you know who couldn’t have afforded it? My mom. There are moms and dads and guardians out there who cannot buy the medicine unless they want to not eat for a few months. I have no words for how enraged I am that profits for the wealthiest should trump ability to survive at all for the poorest.

    *barely stifles guttural roar*

    Liked by 4 people

  9. ACA may not be responsible for prescription prices .but in AZ two of the big insurance companies …Aetna and United Health are pulling out of ACA this year leaving so many people without insurance….scrambling to find anything they can afford. I would love to read a post on that if you could.

    Liked by 2 people

  10. There’s a special place in hell for anyone who thinks this is ‘okay’.

    First, I love that the elephants are coming! 🙂 Brilliant mom moment. Second, I think most people believe their child’s live is priceless. But when these greedy bastards (pardon me) raise the prices like this, the point is, some people just don’t have the money. What a horrific thing to do. Wave your child’s well being in front of you, just out of reach.

    Liked by 1 person

  11. Imagine how many families are affected by this nightmare of a situation. It is ridiculous to put them through this kind of stress in an already stressful life circumstance. I hope the media attention serves some purpose here to expose the greed and insensitivity. How do they sleep ? Indeed.

    Thanks for the post, Doc, and for making it personal. ❤️

    Liked by 2 people

  12. I think it’s just as outrageous to think of it as ripping of the insurance company instead. That money comes from somewhere, and premiums are higher because of it. While pharm is the most obvious target, this attitude is pervasive everywhere. A phone that costs $75 to make might cost $100 to get to market. Why is it then $700 to buy it? Things like assisted living require everything a patient has to get in the door. The whole estate seems to evaporate in a matter of months. Outstanding post, and I’m glad your son was okay.

    Liked by 2 people

  13. I could just hug you right, a doctor saying these things. Thank you from the bottom of my heart. My mother who is dying of renal cancer is being given chemo costing $10,000.00 a month! Instead of saying to my mother please contact Hospice, these doctors are pushing these pills reaping huge monies as a result. And the chemo makes her sicker and is affecting her brain. Medicine is heartless in many aspects. I am so proud of you being in a system that has green in mind first, not the welfare of people.

    Liked by 2 people

  14. It’s interesting that this shows up in my mailbox today after I just watched a show on this same issue yesterday.

    The level of corporate greed right now is unconscionable. Even worse, it is affecting the political process through powerful lobbying thereby corrupting the process that should be putting in the measures to prevent this obscene practice.

    It is morally corrupt. It should be illegal. It’s shocking that it’s not.

    Liked by 2 people

  15. Why should the pharmaceutical bigwigs care about your kid? After all, their kids are healthy.

    Fortunately, mine never needed an epipen, but I did have one who reacted to one of the childhood vaccinations. She reacted exactly the way your son did. Scared the heck of out me.

    Liked by 2 people

  16. I have always felt that business and healthcare did not a good marriage make – when money becomes the bottom line, the care of patients loses its priority. This is such a wonderful illustration of the dilemma, and one that my family faces. My granddaughter and I both have severe food allergies and we have asked these same questions many times. Thank you for posting. Is there a lobby group pushing to have this issue addressed, do you know?

    Liked by 2 people

  17. I forwarded the 1st article on this saga to my daughter in law. My beautiful 9 year granddaughter
    is highly allergic to peanuts. Betty Crocker brownie mix has no nuts, so that is all I make.
    The CEO of Mylan stated schools would be getting sets of Epi pens for students. Tonight
    she is backtracking in saying,,”Some schools will get Epi pens?”
    Angry, oh yes! When it comes to your son, my granddaughter, any allergic person.
    Dear God what is wrong with that’ greedy Mylan??
    Sorry for the rant. My granddaughter has had two episodes, scared me to death.

    Liked by 2 people

  18. I heard about the epipens’ increased costs on the radio the other day and the company is aware of the public’s concern. Their response: they have a coupon for $100 off. What BS. The regular cost, according to the news, in this one city was over $300. Totally ridiculous. There must be another manufacturer out there . . .

    Liked by 2 people

    • There are some people who carry regular syringes. There are a couple of other auto injectors that I have heard mention of but I have never written and Rx for them. One of the things I plan to do in the next few days is educate myself about the options because Mylan does not deserve my business if I can help it. I need to be able to discuss options with patients, too. There are tons of other drugs that have been involved in this price gouging over the past decade. Epipen is just a small piece of the pie…

      Liked by 3 people

  19. The desentization of the peanut allergy to her family is not something they
    would consider., This child has many other allergies, she is on allergy
    medications & regular use of inhalers.
    I did start followng the study a few years ago, it is promising!

    Liked by 1 person

  20. I had to decline medical coverage for now because it will cost OVER $300 A PAY CHECK on my own. I’ll never be able to afford my own place. THREE HUNDRED DOLLARS A PAY CHECK for medical insurance, and that’s without figuring in co-pays for office visits and medication…while the CEOs of big pharma and insurance companies make millions while those of us who barely scrape by have to choose: food or life saving medication…I’d say the justice does turn a blind eye to this kind of inhumane practice.

    Liked by 2 people

  21. As I say, “big pharma” has the peons by the “ying yang.” Greed is everywhere and pharmaceutical companies are one of the worst. The salary for the CEO is a sin. Honestly, how greedy can one person be? I’ve not needed an epi-pen but if I did, I’m sure I’d anti up. The problem is that the companies know that most folks will somehow squeeze out the money. Government needs to do something instead of sitting back on their hands but I doubt that will change, no matter what party is in control.

    I’m so glad that your son made it through that terrifying incident. The horrors of it. I’m sure you’ve relived that moment many times.

    Liked by 2 people

  22. Here going to the dentist is just as bad. Even with the coverage we have from Hubby’s work I can’t afford to go the prices too high the coverage to low and the cap on what they’ll pay is brutal. Our province of Alberta is the highest charging province for dental work. People are actually making the trip to BC to get it somewhat cheaper.
    .

    Liked by 2 people

  23. I saw a FB post in which a distraught mom was saying, “I’m sorry your Epipen costs more than a trip to the hospital for anaphylactic shock.” I don’t know if that’s true or not, but I would be tempted to hold on to the “expired” pens for a while if I were in that situation, though I’m not recommending either of these. No one should be forced to make those kinds of compromises, but I bet some do.

    Liked by 2 people

  24. Price-gouging families, exploiting a monopoly in the market for a product with a household name that saves lives… people carrying syringes as an alternative… this picture is really ugly.

    Whether or not the effects of Congress will be enough, I think I’ll put Mylan Pharmaceutical down on the wrong side of history.

    Liked by 2 people

  25. Anyone willing to accept a salary of $18 million cannot be shamed. This is capitalism, folks. Where the rich can steal legally, and the poor end up in jail just trying to survive.
    My daughter can afford her epipens, but if she was not a working adult, and I had to pay for them, I could not do it. Luckily when she was a child I could manage it.
    Regulation is the only answer. If you want to call it socialized medicine, that’s fine with me. The results for humans matter, not the label. But Congress will never act, never. (K)

    Liked by 2 people

  26. With The Mister in the Army, Tricare paid in full for my epipens, so I always had one. I don’t remember them being so expensive before 2005…
    Since returning to civilian life, I bought the first year’s for $220. I didn’t use it.
    The second year, I got the scrip, but didn’t fill it because $300+
    Now, my insurance pays so much for ER compared to epipens, it’s literally cheaper for me to go to the ER for a shot. I probably won’t die in minutes. Bee stings. Not immediately deadly to Joeys, YET. I did think about it when we drove out to a rural area, but I was lucky.
    I feel badly for people who suffer from severe allergic reaction. It’s too common a problem to be that expensive. :/

    Liked by 2 people

  27. There is no sense to our health care system. I had to pay $60 this month for 30 days of a much needed anti-depressant and yet nothing for an ultrasound to check my thyroid. One of my friends who had cancer was charged $200 for a bag of saline with the chemo – how can this not be racketeering? There is a website called Good RX which shows you the difference in price for the drug in your area (different pharmacies) and also offers discount coupons.

    Liked by 2 people

  28. At one point the bean counters in charge will have to explain their actions. When the state and society as one protest and boycott unreasonably greedy enterprises things change very quickly.

    The Martin Shkreli case is a good example. He became more hated than Tony Hayward after the BP oil spill and that is quite an achievement. Also think about General Motors and the recalls because quality control cuts were costing customer/civilian lives.

    The pharmaceutical industry is on the verge of some shake-ups because there are too many things going wrong. Healthcare is great but when the market is unfairly biased to become unaffordable for even middle-income people, expect serious push backs.

    You already see this push backs when people consider alternative medicine better than what is on offer in the hospitals and doctor’s practices and it is no secret…

    Liked by 2 people

      • Also everybody with decent research skill can find the information to confront the greedy bean counters. With some basic academic research skills you can trace back how and why. The internet made many people smarter.

        Decode the jargon, follow the money and a Pieter Breughel nightmare unfolds. I am not joking…

        Liked by 1 person

  29. Although lawyers are bad, I think pharmaceuticals are the devil in the real world. My nephew-in-law works for a big one and he makes an enormous salary, lives in a ridiculous mansion and he is only a Sr. trainer. He made tons of dough as a sales rep too.They piss more money away on trade shows and other propaganda and then turn around and charge out of this world costs for their drugs because they can. People will pay, insurance will pay….. I am help hostage every two weeks for my drug which is not working very well so that I can get out of bed and move…. the current one runs about $1800.00 a shot. that was not as bad as Otezla which is $80.00 to $100.00 A PILL! And it was crap and almost killed me.
    This whole drug system is a rip and holds everyone hostage. It is criminal.

    Liked by 2 people

  30. Two thoughts. 1) Scary that your son should be allergic. Good you’re a doctor and could react in time. 2) Pharmaceutical labs (who have been among my clients for some years in market research are absolute monsters. They have applied all the evils of Marketing to the industry and none of the good. Prices are downright a steal. They sell yo 2 pills (I think it was for migraine) in an enormous blister (size impression) for 500 pesos. Minimum wage is at 70-80 pesos a day. Keep your migraine buddy.
    (And 18 million bucks? She can’t even spend it. How many yogurts is that?)
    Thank you for this post. I’m sometimes glad I’m not in the market research business any more, that way I don’t have to deal with those sharks. Bonne semaine

    Liked by 2 people

      • Haha! Did I? 🙂 Well, I guess I managed to… turn Marketing around. My duty was to the client. And fortunately I had much more than lab clients. I would have gone crazy. What I did, since I was paid to do recommendations, was to always include the customer side. “This is what you need to do for your customers. Trust me.” Sometimes they listened sometimes not. 🙂
        When they did not I would repeat the reco the following time. Hehe!

        Liked by 1 person

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