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Drug prices keep going up and up and up some more. Is the only explanation for spiraling pharmaceutical costs greed on the part of the drug companies? Can we at least make some kind of sense of the price increases? And what can individuals do?

The cost of fighting disease in the United States keeps going up and up.

If there is any single medication that insulin-dependent diabetics need to stay alive, it's insulin. There was a time that many pharmacies sold insulin at cost because it was simply a decent thing to do. As recently as the year 2000, the wholesale price, which was usually the retail price, of a vial the most advanced insulin of the time was $27. By 2010, that cost had risen to $225. In 2016, insulin is often dispensed in pens, which are simpler to measure but contain only 35 percent as much insulin. To obtain 1000 units of the latest long-acting insulins like Ryzodeg, Toujeo, and Tresiba, uninsured diabetics in the United States have to plunk down over $1400. And some of them will use as many as eight vials of insulin every month.

An even better known drug pricing scandal is the lifesaving EpiPen. Some people are especially allergic to insect stings or other allergens. Contact with an offending substance can cause swelling of the lips, swelling of the tongue, and swelling of the throat (along with hives, swollen eyes, nausea, vomiting, and other symptoms) that can result in quick death without immediate treatment. The treatment of choice for these kinds of reactions is epinephrine. Injected into a muscle, it can produce immediate relief and prevent death by anaphylaxis.

If you know how to draw epinephrine into a syringe and have the presence of mind to give yourself your own injection, it would be enough buy a vial of epinephrine, which retails for as little as $1.25, and a syringe, which you have to buy in packs of 10 for about $1.25 a pack. As little as $2.50 would buy lifesaving protection. However, because most people who have allergies, and parents of children who have allergies, are understandably excited when they are confronted by life-threatening allergic reactions, the delivery vehicle of choice is the EpiPen, which comes in a two-dose set. Sometimes a second dose of epinephrine is required for a particularly severe allergic reaction.

When drug maker Mylan acquired the rights to sell EpiPens in 2007, the wholesale price of the device was $103.50. That's what the pharmacy paid. Maybe out of the goodness of their hearts the pharmacy made the pens available at cost to the poor, but most people, and certainly their insurance companies, would pay considerably more. By July 2013, the wholesale price of the pen was $264.50. In August 2015, it was $461.  By 2016, Mylan had raised the price of the pen to $608.61, and keep in mind, that's the price to the pharmacy, not the cost to the customer. Its costs of production had not increased, and it's not like epinephrine is going out of style. People who buy their products continue to need them for life and the number of people who need EpiPens and similar devices is only increasing. 

When confronted by consumer outcries, Mylan issued $100 coupons for lower-income customers. However, even with the $100 coupon, and health insurance, in many cases a two-pen pack still cost the user $400. And because the pens expire in a year, many families have to buy more about the same time they have to buy school supplies.

Continue reading after recommendations

  • Katie Thomas. The Complex Math Behind Spiraling Prescription Drug Prices. New York Times. 24 August 2016.
  • infographic by SteadyHealth.com
  • Photo courtesy of SteadyHealth.com
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