While facing intense outrage for repeatedly raising the price of their life-saving epinephrine autoinjectors, Mylan continually argued that patients were protected from the skyrocketing list price — thanks to insurance coverage, rebates, and rebates. But a new investigation into insurance claims casts doubt on that defense.
Between 2007 and 2014, average out-of-pocket expenses per insured EpiPen user increased by 123 percent. During that time, Mylan raised the list price of EpiPens from about $50 per pen to a whopping $609 per two-pack. In 2007, the year Mylan acquired the rights to EpiPen, the average patient spent about $33.8 out of pocket for a two-pack. According to the new analysis released Monday in JAMA Internal Medicine.
The numbers do not match Mylan’s insurance policies. The company repeatedly claimed that most patients were not significantly affected by the price hikes and only paid $50 out of pocket or less. Reuters reports that Mylan even claimed that about 90 percent of patients paid so little.
To get to the real numbers, authors Kao-Ping Chua and Rena Conti of the University of Chicago dug through insurance claims from 191.2 million patients between 2007 and 2014. While not all EpiPen users are insured, the records accounted for 70 percent of all EpiPen prescriptions — a solid portion of Mylan’s overall customers.
The researchers first noted that while the total number of prescriptions increased over the period, the number of prescriptions filled per patient did not change significantly.
But as the list price rose, more people saw higher bills. The share of insured patients paying more than $100 out of pocket rose from 3.9 percent in 2007 to 18 percent in 2014. The share paying more than $250 also rose dramatically, from 0.1 percent to 7.4 percent.
Overall, the average total out-of-pocket expenditure on EpiPens per patient per year increased from $123.9 in 2007 to $468.7 in 2014.
“Especially for EpiPen, not filling a prescription because of cost can mean the difference between life and death when severe allergic reactions occur,” Chua told WebMD. Reuters in an email. “This is why Mylan’s EpiPen price hikes are so ethically troubling.”
Since the backlash, Mylan has introduced a $300 generic EpiPen, and some insurance companies are now refusing to cover the brand-name version. In January, CVS and Impax Laboratories announced a deal to offer an alternative that costs $109.99 with or without insurance. With a coupon from Impax, the price drops to $10.
JAMA Internal Medicine2017. DOI: 10.1001/jamainternmed.2017.0252 (About DOIs).