With all the talk about rising cost of EpiPens, it’s important to remember who this situation impacts the most. At-risk and food insecure families. There has been a lot of media attention recently focused on the price of EpiPens, but these families, who are already living paycheck to paycheck, have been bearing the burden of added anxiety over whether they can afford the only life-saving medication available for their children for years. Add in what I most recently learned about the limitations of some ambulances to carry and use epinephrine and there may be a healthcare superstorm brewing on the horizon.
By way of background…
It’s all over the news: EpiPen prices have climbed over 400% in the last 10 years, making this one and only lifesaving drug nearly – if not completely – unaffordable for many families. Ten years ago, a pair of EpiPens cost between $75 and $100. Today, they are sold for $600-700. Understanding that families need multiple sets (for school, aftercare programs, home and on-the-go), the financial burden becomes even greater.
While there may be programs that do benefit families with certain kinds of healthcare plans and help mitigate the cost of EpiPens, there are a significant number of families who are struggling to justify the cost of this medication. These aren’t always low income families, some are typical middle class families who earn just enough to take care of their current needs. The rising cost of EpiPens is tipping that delicate balance unfavorably.
As EpiPen prices soar, so does the cost of NOT carrying them.
Given the high cost of EpiPens coupled with their relatively short shelf life, families are being forced to make a difficult choice. And some are choosing to forego filling their prescriptions. More and more, families whose finances are stretched thin are relying on emergency responders as their first line of defense should a severe allergic reaction occur. They are operating without a safety net and hoping that emergency medical care will catch them.
But what do you do if the ambulance you’re waiting for isn’t carrying epinephrine? What if the EMT that arrives isn’t authorized to administer it?
This is the case in many cities and counties across the United States. The ability to carry epinephrine as well as the local protocols authorizing EMTs to administer it vary from place to place. [Please read: Does Your Ambulance Carry Epinephrine?]
This collision of high EpiPen costs and the inconsistent ability of emergency responders to help may cause a far larger problem. Already low income families* pay 2.5 times more per year on emergency room visits and hospital care than higher earning families. And, in a 2013 study conducted by FARE, results showed that when people suffering from anaphylaxis used emergency care, epinephrine was not usually used to treat their condition. It appeared to the researchers that even seasoned emergency medical professionals were reluctant to use epinephrine – despite the fact that it is known to be a safe drug with few short-term side effects.
In FARE’s study, 58% of those who called 911 administered epinephrine before an ambulance arrived. In a life-threatening situation when every second counts, what will happen if more cases of anaphylaxis arrive at the emergency room without having received epinephrine on scene OR en route? It appears many will also not receive it in the emergency room either.
How will lower-paying municipalities compete with higher paying counties and cities to retain competent, capable paramedics and advanced EMTs (those most often allowed to administer epinephrine)?
What role does cost play in local government decision-making regarding whether or not to stock ambulances with EpiPens and who has the authority to administer them?
These are only some of the unanswered questions that are starting to boil to the surface. I hope Mylan’s expanded efforts to get EpiPens in more hands helps some of these at risk families. But I remain concerned that the confluence of high prices and inconsistent policies governing emergency medical use of epinephrine will continue to cause a ripple effect across the healthcare spectrum. I just hope it remains a ripple and not a tidal wave.
* A study, co-authored by Dr. Richi Gupta, published in Pediatrics defined low income families as those earning less than $50,000 per year.