Prices of prescription drugs in the United States are among the highest in the world. Most recently, the skyrocketing price of the epinephrine pen, EpiPen, has been the subject of major news headlines. Many have been enraged by the dramatic price increase of the EpiPen ($100 to over $600 in the span of a few years). Unfortunately, the EpiPen is one of many prescription drugs that has been affected by such dramatic inflation. Many fear that the rising cost of life-saving medication will limit access to those who need it. Healthcare providers cannot stand idly as these changes negatively impact patients. We need to have a better understanding of the prescription drug industry so that we can find reasonable solutions for our patients.

The rising cost of the EpiPen is of special interest to the pediatric community. The epinephrine pen is a life-saving medication for anaphylactic reactions, a life-threatening reaction that more commonly affects children. According to the Centers of Disease Control and Prevention (CDC), approximately 3.9% of children have a food allergy, the leading cause of anaphylactic reactions.¹ The risk of fatal outcomes is significantly increased when there is a delay in epinephrine administration. Therefore, accessibility to epinephrine is critical for all patients who suffer from severe allergies. Even government officials have recognized the importance of the EpiPen and have pushed legislation to mandate schools to carry a supply of them. In fact, on November 13, 2013, President Obama  signed a law that would provide incentives to states that implement  such a legal mandate .

The controversy of the rising cost of the EpiPen has led to a political debate regarding the lack of existing regulations for medication pricing. Unlike many other developed countries, the United States government does not pose any regulations for medication pricing by pharmaceutical companies. In fact, the intellectual property laws related to patents and trademarks allow pharmaceutical companies to effectively monopolize new drugs in the market for years. Only after a drug’s patent has lapsed can other companies develop less expensive, generic forms of the drug. According to the Generic Pharmaceutical Association, brand name drugs make up only 10% of dispensed drugs but account for 72% of all drug spending.²  Pharmaceutical companies claim that such high price tags are necessary for further research and drug development. However, most high profile pharmaceutical companies allocate a fraction of their budget (10-20%) to research.³

Healthcare providers should recognize that rising costs  threatening patient care by limiting access to medications. In addition to participating in  policy making, pediatricians need to be more cognizant of the price burden medications may have and find more creative ways to ensure accessibility to medication. For example, Dr. Welch from the American Academy of Pediatrics suggests that pediatricians may recommend the cheaper, generic form of the epinephrine pen called Adrenaclick.⁴  Similar substitutions may work for other expensive drugs.

Noor W. Nema, MD

References:

1. Branum, Amy M., and Susan Lukacs. Food allergy among US children: trends in prevalence and hospitalizations. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2008.
2. Generic Pharmaceutical Association. Generic drug savings in the US. http://www.gphaonline.org /media/wysiwyg/PDF/GPhA_Savings_Report_2015 .pdf. Published November 3, 2015. Accessed July 13, 2016.
3. Kesselheim, Aaron S., Jerry Avorn, and Ameet Sarpatwari. “The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform.”JAMA 316.8 (2016): 858-871.
4. Jenco, Melissa. “AAP urges action on EpiPen costs, suggests options.” AAP News (2016).