This article is from the source 'nytimes' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.

You can find the current article at its original source at http://www.nytimes.com/2016/08/26/business/epipen-mylan-price.html

The article has changed 3 times. There is an RSS feed of changes available.

Version 0 Version 1
Mylan to Lower EpiPen Cost for Some Patients Mylan to Offer Some Patients Aid on Cost of EpiPens
(about 11 hours later)
Responding to a growing furor from consumers and politicians, the pharmaceutical company Mylan said on Thursday that it would lower the cost to some patients of the EpiPen, which is used to treat life-threatening allergy attacks. Responding to a growing furor from consumers and politicians, the pharmaceutical company Mylan said on Thursday that it would lower the out-of-pocket costs to some patients who need EpiPens, which are used to treat life-threatening allergy attacks.
The company said it would take immediate action, including providing a savings card that would cover up to $300 of the cost of a pack of two EpiPens, an increase from the $100 savings card it had been offering. The company said it would immediately offer more financial assistance with co-payments for patients with commercial insurance and expand the number of uninsured patients eligible for free EpiPens.
It also said it would increase the number of patients eligible for its assistance program, which provides the product free to patients who have incomes below a certain level and lack insurance coverage for drugs. But the moves did not mollify critics of Mylan because the company did not lower the list price of the EpiPen, which has risen to $600 for a pack of two from about $100 in 2007.
Mylan has steadily increased the price of EpiPen — a pack of two now has a list price of about $600, compared with about $100 when it acquired the product in 2007. In the last couple of years, the company has imposed two 15 percent price increases a year. So the total cost to the health system, a cost borne largely by insurers, the federal government and school districts, will remain the same.
This has provoked outrage from some parents who are confronting the higher prices as they buy the product for their children returning to school. The Democratic presidential nominee, Hillary Clinton, said on Wednesday that it was “outrageous” to increase so drastically the price of a product that people needed to survive. Members of Congress have also called for investigations into Mylan’s practices. “Mylan should not offer after-the fact discounts only for a select few — it should reverse its massive price increases across the board immediately,’’ Representative Elijah E. Cummings of Maryland, who has been investigating rising drug prices, said in a statement.
The new moves will probably not fully mollify the critics. For one thing, Mylan is not lowering the list price of EpiPen, just making it easier for consumers to pay for it. So insurance companies, federal health programs like Medicare and Medicaid and school districts that stock the products could still pay the same price. In its announcement of the new measures, Mylan put much of the blame for the problem not on its price increases but on insurance companies for placing a higher burden on patients for out-of-pocket costs.
Also, in its statement, Mylan put much of the blame for the problem not on its price increases but on insurance companies for placing a higher burden on patients for out-of-pocket costs. “We have been a long-term, committed partner to the allergy community and are taking immediate action to help ensure that everyone who needs an EpiPen Auto-Injector gets one,” Heather Bresch, Mylan’s chief executive, said in a statement.
“We have been a long-term, committed partner to the allergy community and are taking immediate action to help ensure that everyone who needs an EpiPen Auto-Injector gets one,” Heather Bresch, Mylan’s chief executive, said in a statement. “We recognize the significant burden on patients from continued, rising insurance premiums and being forced increasingly to pay the full list price for medicines at the pharmacy counter.” “We recognize the significant burden on patients from continued, rising insurance premiums and being forced increasingly to pay the full list price for medicines at the pharmacy counter.”
The EpiPen is an auto-injector containing the hormone epinephrine, which can be used to counter or stave off anaphylactic shock caused by an insect bite or food allergy. It is pressed against the thigh and automatically injects the drug. The EpiPen is an auto-injector containing the hormone epinephrine that can be used to counter or stave off anaphylactic shock caused by an insect bite, bee sting or food allergy. It is pressed against the thigh and automatically injects the drug.
Mylan said most commercially insured patients were already being helped by its savings coupon and many paid no out-of-pocket costs. But more patients now have high-deductible health plans and were having to pay the full cost. For those patients, using the $300 savings card would cut their costs by half. Mylan said that out of the $608 list price for EpiPen, it gets only $274. The rest goes to pharmacy benefit managers, insurers, wholesalers and retail pharmacies.
Also, the company’s patient assistance program will now cover those with incomes up to 400 percent of the federal poverty level, compared with 200 percent previously. Offering co-payment assistance and free product is part of the standard playbook for makers of expensive drugs. Making sure patients do not go without medicines reduces any political furor. Also, providing financial assistance only to those who need it reduces a pharmaceutical manufacturer’s revenue much less than cutting prices across the board.
Mylan said it would also allow patients to order EpiPens directly from the company, reducing their cost. The discounts call attention to how the out-of-pocket costs for drugs vary widely for consumers, depending on their insurance coverage.
Mylan also said that more than half the amount paid by the health care system for EpiPens goes to pharmacy benefit managers, insurers, wholesalers and pharmacy retailers, not to the company itself. Here is how it breaks down for EpiPen after the measures announced by Mylan on Thursday.
The company said its net price for the product — what it actually receives after rebates, discounts, patient assistance and product donations — is $274 of the list price of $608, resulting in annual sales of $1.1 billion to the company from the product. The other parties, it said, get $334 per prescription, or $1.3 billion a year. The largest group of EpiPen users, accounting for an estimated 70 percent of the total, have commercial insurance. These patients usually are responsible for co-payments. If their insurance policy has a high deductible that has not yet been met, patients might have to pay the full price for EpiPen.
The pharmaceutical industry, under siege for high prices, is trying to point fingers at insurers and pharmacy benefit managers. Stocks of biotechnology companies dropped across the board on Wednesday after Ms. Clinton criticized Mylan and vowed to take action on drug prices if elected. For these patients, Mylan is offering a savings coupon worth up to $300, which can be obtained from the prescribing physician or the EpiPen website. Previously it had offered a coupon worth up to $100.
So patients with co-payments of less than $300, which means most patients, would have no out-of-pocket cost if they use the coupon.
If an insured patient is paying full price because of a high deductible, the coupon will cut the cost in half, to about $300 from $600.
Another group, accounting for only about 5 percent of EpiPen users, have no insurance or insurance without prescription benefits. They typically have to pay the full price.
Mylan will now give free EpiPens to uninsured patients with incomes below 400 percent of the federal poverty level. (The company said the limit would be $97,200 for a family of four.) Previously the limit was 200 percent of the poverty level. Patients have to apply for this every year and provide financial information and documentation.
People covered by federal programs like Medicare, Medicaid and the military’s Tricare will not see any difference. Drug companies are not allowed to provide co-pay assistance to such patients because it is considered a kickback, an illegal financial inducement to get someone to use a product for which the government is then billed.
Some drug companies give money to charities that are allowed to provide co-pay assistance to such patients. But there does not appear to be one available for the EpiPen.
People with Medicare coverage can encounter big out-of-pocket costs for drugs, especially if they enter the so-called doughnut hole. Medicaid can require co-pays for certain patients. But a spokeswoman for Mylan said that more than 90 percent of Medicare and Medicaid patients have coverage for EpiPen.