Allergies are Expensive
Clashing opinions are what make up the bulk of the press in the United States. Many argue in one direction and the rest in others. One undeniable trait the US holds is the high price of healthcare and health-related products. In any case, treatments can cost you an exorbitant amount and even more without the aid of insurance. Millions across America are burdened with medical costs too high to afford, and it’s almost always for something they can’t help.
Every year, over 100 million Americans experience some type of allergy, and it’s estimated that up to 5% of the US population experience anaphylaxis, a sometimes fatal condition resulting from an allergic reaction (Turner et al., 2017). Whether the reaction is through bee stings, tree nuts, or something completely different, the potentially fatal symptoms can be quickly reversed using epinephrine, typically packaged with an Epi-pen. Annually, millions of Americans are prescribed an epi-pen. Despite the importance of this product, many cannot afford it because of the monopolistic market it’s akin to.
Mylan, a company that merged with Pfizer in 2021, is the main provider of epi-pens in the US, controlling most of the market for epinephrine. Breaking into this market isn’t an easy task as the FDA requires extensive research on both the injector and the medication itself, which is expensive and difficult research to conduct (Marsh, 2023). Using their market power, Mylan increased the price of epi-pens by over 500% between 2009 and 2016 alone (Miyashiro, 2017). This price hike led to outrage in the public, as many could no longer afford the lifesaving medicine. The American public responded to this change through a handful of lawsuits, to which Mylan released a “generic brand” that was a few hundred USD less than its counterpart. Despite their efforts, epi-pens still cost between $650 and $750 today, and their generic line costs between $300 and $500 (Marsh, 2023).
After reading this, you may wonder if the cost to produce one dose of epinephrine justifies the market price. It was estimated that Mylan's patented auto-injector costs between $15 and $40 to make, with some sources estimating the entire production of a two-pack costing under $10 (Miyashiro, 2017). In 2016, the average wholesale price for one vial (1mg) of epinephrine was only $2.52. On top of this, an epi-pen dose only contains 0.3mg of epinephrine; based on the latter pricing, one dose of epinephrine would only cost around 80 cents to produce. Although this was nearly a decade ago, the pattern of an unethical markup on this product is shown with the cost of an epi-pen in 2016, sometimes reaching over $600 (Westermann-Clark et al., 2018).
Unfortunately, huge markups on necessary healthcare products in the US aren’t uncommon. People with life-threatening, untreatable conditions have an extremely high willingness to pay, as they need treatment to survive, allowing companies to charge nearly any figure they want to without losing demand or their customers. This trumps any cost that a product may have and is also found in the market for insulin.
In 2021, 38.1 million Americans had diabetes, 2 million of which had type 1 diabetes (American Diabetes Association, 2023). Insulin is necessary for people with type diabetes as it keeps their condition at bay and allows them to live healthily. The diabetes pandemic is continuing to grow worse annually, according to the CDC; however, the prices of insulin are still remarkably high.
The production of one vial of insulin is estimated to cost between $2 to $4, yet in mid-2023, the retail price cost as much as $250 (Crawford, 2023). Later in 2023, as a part of the Inflation Reduction Act, Democratic legislators passed an agreement with Novo Nordisk, an insulin company, to cap the monthly price of insulin for those with Part D Medicare at $35 a month, dropping the price of insulin by 70% for eligible Americans (White House, 2023). Although there are some exceptions, Part D Medicare is primarily age-based, and mostly includes adults over 65 (Plemons, 2023). The democratic party attempted to include those with private health insurance in this bill; however, it was successfully stopped by the Republican Party, forcing millions of Americans without Medicare to continue paying high prices for insulin regardless of whether they could afford it. (Lovelace Jr., 2022)
Despite their changes, the United States still holds the record for the most expensive insulin costs in the entire world. Globally, there has been a massive drop in price per dose of insulin; however, it’s important to remember that there is still a massive willingness to pay for the product as it is a matter of life or death for hundreds of thousands.
Lowering the prices of critical medicine will cause businesses to lose out on profits, which would make this a bad business decision. Viewing this dilemma from an ethics-focused point of view would quickly show otherwise, and state that improving the quality and length of life for any person would be of far greater value than a company’s extra profits- a statement which most people would likely agree with. The gradually declining prices of epi-pens and insulin are a step in the right direction; however, there is still much work to be done to ensure an equitable and affordable market for life-improving and even lifesaving products.
Works Cited
AAFA. (2023, November 21). Allergy facts. Asthma & Allergy Foundation of America. https://aafa.org/allergies/allergyfacts/#:~:text=More%20than%20100%20million%20people,types%20of%20allergies%20each%20year.&text=Allergies%20are%20the%20sixth%20leading%20cause%20of%20chronic%20illness%20in%20the%20U.S.
Attorney general James secures agreement with insulin maker Novo Nordisk to cap insulin prices for uninsured New Yorkers. New York State Attorney General. (2023, September 8). https://ag.ny.gov/press-release/2023/attorney-general-james-secures-agreement-insulin-maker-novo-nordisk-cap-insulin
Marsh, T. (2023, June 26). How much is an epipen? learn about the costs and 4 ways to save. GoodRx. https://www.goodrx.com/epinephrine-epipen/how-to-save-cost
Mylan’s epipen pricing scandal. Seven Pillars Institute. (2017, September 14). https://sevenpillarsinstitute.org/mylans-epipen-pricing-scandal/
NBCUniversal News Group. (2022, August 16). Inflation reduction act becomes law: How it will affect your health care. NBCNews.com. https://www.nbcnews.com/health/health-news/inflation-reduction-act-becomes-law-will-impact-health-care-rcna43090
Plemons, C. (n.d.). Medicare part D eligibility | . eHealth. https://www.ehealthinsurance.com/medicare/eligibility/who-qualifies-for-a-medicare-part-d-prescription-drug-plan/
Statistics about diabetes. Statistics About Diabetes | ADA. (n.d.). https://diabetes.org/about-diabetes/statistics/aboutdiabetes#:~:text=Prevalence%3A%20In%202021%2C%2038.4%20million,of%20the%20population%2C%20had%20diabetes.&text=Diagnosed%20and%20undiagnosed%3A%20Of%20the,and%208.7%20million%20were%20undiagnosed
The United States Government. (2023, March 2). Fact sheet: President Biden’s cap on the cost of insulin could benefit millions of Americans in all 50 states. The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2023/03/02/fact-sheet-president-bidens-cap-on-the-cost-of-insulin-could-benefit-millions-of-americans-in-all-50-states/
Turner PJ, Jerschow E, Umasunthar T, Lin R, Campbell DE, Boyle RJ. Fatal Anaphylaxis: Mortality Rate and Risk Factors. J Allergy Clin Immunol Pract. 2017 Sep-Oct;5(5):1169-1178. doi: 10.1016/j.jaip.2017.06.031. PMID: 28888247; PMCID: PMC5589409.
Westermann-Clark E, Pepper AN, Lockey RF. Economic considerations in the treatment of systemic allergic reactions. J Asthma Allergy. 2018 Jun 20;11:153-158. doi: 10.2147/JAA.S159851. PMID: 29950874; PMCID: PMC6016598.
What are the dosing guidelines for the EpiPen® Auto-injector?. What are the dosing guidelines for the EpiPen® Auto-Injector? | Epipen.ca. (n.d.). https://www.epipen.ca/node/25#:~:text=The%20EpiPen%C2%AE%20Auto%2DInjector%20is%20intended%20for%20intramuscular%20administration,0.3%20mg%2F0.3%20mL
Yale School of Medicine. (2023, April 27). The price of insulin: A Q&A with Kasia Lipska. Yale School of Medicine. https://medicine.yale.edu/news-article/the-price-of-insulin-a-qandawithkasialipska/#:~:text=Insulin%20is%20seven%20to%2010,produce%20a%20vial%20of%20insulin.
