How much would you spend on a drug that could save your life?
That's a question that people with food allergies are forced to grapple with as the cost of a drug that could save their lives rises higher and higher.
The medication is called EpiPen. It's an auto-injector filled with epinephrine, a drug that can stop an allergic reaction.
Jacob Andrews carries an EpiPen with him at all times. He's one of an estimated 15 million Americans who have a food allergy.
Andrews is allergic to cashews and Brazil nuts. If he accidentally eats something that contains one of those nuts, he feels it.
“I kind of lose some breathing abilities, my airways start to close up a little bit, my stomach hurts really bad, I throw up for maybe a day," he said.
Andrews discovered he was allergic when he was 8, when he had a terrible reaction to eating a piece of See’s candy. At the hospital, doctors diagnosed his food allergy.
The 18-year-old from San Diego is now a freshman at Sonoma State University and still has to be careful about what he eats. If he ever gets exposed to cashews or Brazil nuts, he'll pull out his EpiPen.
“So, you have to take the cap off of it, and there’s a needle that isn’t exposed ‘cause they don’t want to freak you out," Andrews said. "It’s like inside, and then you just have to push it hard up against your outer thigh and click the back, and the needle goes in. And you just hold it there for 10 seconds and then take it out.”
The drug isn't cheap
EpiPens are sold only in pairs. That’s because some people may need two injections to combat a severe allergic reaction.
A few months ago, before Andrews went off to college, his mom, Julie, went to the pharmacy to buy a pack of EpiPens.
“And it was $600," she said. "And it was like, I was completely in disbelief.”
The Andrews family's insurance company doesn’t cover EpiPens. And there’s virtually no other product on the market that's similar.
“It’s a life-saving medication," Julie Andrews said. "So what choice do you have? You have to pay for it.”
EpiPen price, sales go up
The Netherlands-based pharmaceutical giant Mylan makes EpiPens. Over the past five years, according to Evercore ISI, an independent banking advisory firm, Mylan has raised the price an EpiPen an average of 27 percent a year.
Sales of EpiPens have skyrocketed, too, despite the price hikes.
That’s because the number of children with food allergies has gone up, said San Diego allergist Michael Welch.
“We’ve seen a doubling of kids in the country over the last 10 years with peanut and tree nut allergies," Welch said. "And those are the ones that are the most life-threatening when they do have allergic reactions.”
EpiPen isn’t the only drug that some consumers consider to be overpriced. Cancer drugs, for example, can cost a patient tens of thousands of dollars.
But patients who pay for cancer drugs take them. An estimated 95 percent of EpiPens are never used.
One reason: EpiPens have a short shelf life. They expire within 16 to 18 months, so people have to buy a new set about every year-and-a-half.
Who determines the price?
Mylan declined to be interviewed for this story. In a written statement, the company said drugs in liquid form such as epinephrine do not last as long as pills and tablets.
And regarding the price of EpiPens, Mylan said insurance companies and pharmacies make the final decision.
Wendy Patrick is an attorney and lecturer in business ethics at San Diego State University. She said she believes Mylan has consumers over a barrel.
"Because if you ask parents, what’s the cost of a child’s life, the answer is going to be 'priceless,'" Patrick said. "That means they’re going to have to pay whatever you decide to market that drug."
Most health insurers cover EpiPens. But people who have high-deductible plans are forced to pay the retail price.
Is the price a barrier?
Welch is concerned that some of his patients aren’t willing or able to shell out the money.
“They’re either putting off a renewal, or they’re not even getting the prescription that I started them on when I decided they needed to have one," Welch said. "I’m worried that this is a barrier. It’s a barrier that’s putting them at risk for having a serious allergic reaction.”
Jacob Andrews thinks the situation is totally unfair.
“I think for a necessity, especially for people who are born with this allergy or have developed this allergy, they should be able to get the care they need at a price they can afford," he said.
