CIGNA stops covering epi pen

Parent Cafe
41

Wow, some big misconceptions by some posters here.

Many drugs, including brand name drugs, are made overseas in India, China and many other countries. The FDA regulates drug manufacturers overseas as well as domestically in terms of setting standards for production. I am talking about legally imported drugs, not drugs purchased outside of the legal pipeline. Just because a drug comes from India or China or anywhere else (if legally imported) does not mean it was made unsafely, and it should not be said that all such drugs are all unsafe.

Also, if someone wants to say that generics are not efficacious, he or she should say what drug is at issue, because generics must pass FDA muster, and are supposed to be the same as the patent drug.It should not be true that a generic “doesn’t work.” The generic must be proved to be bioequivalent to the patent drug. This is expensive, but not as expensive as a new drug application. Many generics are made in the same factory as the patent medication. Let’s not tar all generics with a brush of ineffective, as this is simply not true.

As to the epi-pen, this is a drug and device, all in one. More complicated than just the bioequivalent generic in terms of approval. I have no particular information about this medicine. However I am familiar with one example of where a drug company was charging an outrageous amount for what was not a novel drug at all.

Also, in terms of obtaining name brand drugs with a copay coupon, I want people to be aware of some issues. The manufacturer may pick up the copay, but the charge to the insurance company may still be monstrous. If you care to , see this article
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816160/

I am particularly familiar with Solodyn, mentioned in the article. This is minocycline, and nothing special about it, except that the clever executives at the Medicis company realized that they could change the milligram dosage of the pill by a few milligrams more or less and have it approved as what is, in essence, a “branded” generic that they charged hundreds of dollars for to the insurance company. Instead the patient could have just received generic minocycline (which, BTW, is safe). They raised the cost of treating acne from dollars a month to hundreds of dollars a month. All so their executives could have huge salaries, stock options and other compensation. If your insurance premiums have increased, you should care that this type of stuff goes on.

42

One thing to keep in mind is that the new administration is taking aim at the profits that the drug companies are making and he is also suggesting that plans be able to negotiate with them for prices. He indicates that this is going to be great and will lower costs. I think we can all be glad when the prices finally come down. Cigna will most likely pick it back up once the prices come down.

43

I know I have no info about what my insurer is paying on my behalf for my Rx. Some years ago, my receipt showed what insurer paid and my copay. Now I only get a receipt with my copay, so I can’t know without asking the pharmacist how much my insurer paid and am not sure they know.

44

@sryrstress - you need 2 epi pens because the dose wears off in about 15 minutes. If you’re not under the care of EMS by then, you may need a second dose. Also there is value in an injector that can just be jabbed quickly into your thigh. During the time you take to draw up a dose of epi, you may pass out from anaphylaxis. In fact, it’s a good idea for family members to learn about using the injectors, because of the risk of rapid loss of consciousness with anaphylaxis.

ETA: epinephrine is one drug I wouldn’t take a chance on in terms of using an expired syringe. You should only be using it if you are at risk of dying, so if it’s ineffective, you have a problem.

45

Everybody here knows that the Epipen or other adrenaline source is just to let the Benadryl take effect, right? Or, at least, that’s the way it was explained to me. You do the Epipen, then take the Benadryl. The adrenaline wears off in 15 minutes, and then if the Benadryl hasn’t yet taken effect, you are still in the life-threatening emergency situation and you use the second Epipen (or other device).

I learned about this in a Wilderness First Aid class. For the purposes of the class, the patient was hours away from an emergency, so we needed to know how to handle the issue.

We were told that it’s illegal to use one person’s Epipen on another person. There was a bit of wink-winking there, because if you have a person dying in front of you, are you going to let them die, or grab the other person’s Epipen and give it to them?

46

No one ever told me to take Benedryl after the epi-pen. I guess I’ll ask my allergists and pulmo about that.

47

@MassDaD68 #41. There’s a reason the pharmaceutical industry has been untouchable in terms of constraining prices. It’s easy to say that Big Pharma will bend to the negotiating skills of the new administration. But he’s going to run into a brick wall in congress, where some of the most powerful members are heavily subsidized by the industry, which will not take kindly to legislation which cuts into their profits.

48

This is not Big Pharma, folks. This is scum trying to get every bit of the profit any way they can. Sure, pile on. But bend the stick too much, and there will be no one left to develop immunotherapies etc. of tomorrow.

49

hlmom
I learned…epi first followed by benderyl and straight to the hospital. (always those 3 things)

50

I think one of the core issues is that the government is legally prohibited from negotiating drug prices for Medicare. Which just sounds too crazy to actually be true, but there it is. That law would need to be changed in order to allow negotiation on prices; I hope it happens.

A valid point and one that’s brought up very often when people complain about drug prices. But knowing that the US pays the highest prices for drugs in the world, and people go across the border to Canada to buy the exact same drugs for significantly less, the question becomes: do we in the US need to be the ones subsidizing drug development for the rest of the entire world? Or can we push for a more fair model so we’re not paying 2x - 10x more for the exact same drugs as other countries?

BTW, the $600 EpiPen we’re talking about on this thread costs $69 in Britain.

https://www.bloomberg.com/graphics/2015-drug-prices/
http://www.economist.com/blogs/economist-explains/2016/09/economist-explains-2

51

Due to my daughter’s life threatening allergy to peanuts, when she was a child, there were Epi Pens everywhere! School kept one, she had one in her backpack, one in her dance bag, I had one, and one at home. I refilled those as soon as they hit the expiration date; of course that was when they were $20 a piece. Now as an adult, she still makes sure she has a few fresh one on her at all time.

Due to her rebound reaction, she has to go straight to the ER and stay there for 6 hours; that is just what her allergist decided was best for her. She was actually on a trip during college when a friends roommate made chocolate chip cookies with peanut flour; ended up spending the day in the ER!

52

@anomander:
That is one of the problems with drug prices, in effect the US is subsidizing the rest of the world. Some of that is through the research grants for basic research that can lead to new drugs the government does, but the other part is the US unlike almost every other country does not put price limits on drugs, so what happens is drug companies do the famous “cost shifting” that medical providers do, they offset the losses on selling it in other countries by making it more expensive here.

@bunsenburner is correct, it is very easy to talk about greedy big pharma (and small pharma), and that no doubt exists, but there also is a legitimate reason drugs are expensive, it is costly to develop a new drug and then test it, plus for every successful one there are a lot that don’t make it (I don’t remember the ratio, @bunsenburner do you know offhand the failure to success ration? I recall it was easily 5 to 1, if not much larger).

The only way such price controls would work would be for there to be international cooperation, where price levels would be set based on a reasonable rate of return on investment, but I doubt that would happen, if you had hedge funds and other high priced stockholdes involved, they would demand double digit ROI on any drug factoring in the losses for the failures. In theory, along with this agreement, they could also extend the patent length on a drug in return for keeping the cost down to the agreed on ROI (though what we have seen is drug companies pushing for longer patents while keeping the prices the same).

Mylen labs and Shvilli and the like is just a company taking advantage of basically a monopoly situation to jack up the price of something with quite honestly very little cost to them, the cost of developing a new injector pen, for example, is nowhere near a new drug (and that assumes the new injector is anything more than cosmetically different from the old one). Shvilli was even worse, he basically bought a drug company already making the products (no new costs involved), and jacked up the price astronomically, there was no regulatory action involved, no new lines. At least when they restask a drug, they have to go through clinical trials to prove effectiveness, so there is cost, but this?

53

People quite reasonably expect drugs and medical devices to meet some level of safety and effectiveness. The trials and regulatory approval process exist for this purpose. However (and there is probably no way around it), that means that there is a relatively high barrier to entry that delays or discourages the entry of new competitors into the market, even when a “greedy monopolist” situation would ordinarily invite new competitors to enter the market. That is in addition to any patents that may exist, of course.

The other difference in the market for drugs and medical devices is that, for many such products, the users do not have as much choice to go without. In monopoly situations involving optional purchases, people who think that the price is too high just do not buy. But people who need to carry epinephine for life threatening allergy risks are less likely to want to risk going without an auto-injector.

54

@ucbalumnus :
Well said, it is a fundamental problem with health care in general, should something so critical be allowed to shift in the winds of the free market, either wholly or in part? It is much like health insurance, there are those who promote the idea of competing health insurance companies, but the reality is the barrier to entry to starting in health insurance is huge, there is no such thing as mom and pop health insurance, the needed capital reserves are huge. Likewise, unlike let’s say tv sets, there is no economy of scale to the insurance side of it, that would allow cheap, full service health insurance (on the treatment side that is a different story). When you have something critical like medicine, the free market model is not a very efficient answer because it really isn’t a free market, the barriers to competition as you point out are too high.

55

@musicprnt - here is a good summary of the likelihood of approval rates for drugs in various categories.

https://www.bio.org/sites/default/files/Clinical%20Development%20Success%20Rates%202006-2015%20-%20BIO,%20Biomedtracker,%20Amplion%202016.pdf

Please note that LOA refers to the chances of a drug entering Phase I making into clinic. For every Phase I small molecule drug, hundreds if not thousands of compounds are usually made and tested…

56

It makes no sense to me that the US alone is supposed to be paying for all the R&D of the entire world. There are other 1st world countries that can and should share the burden.

57

^^And they do. Many of these cos are multi-national.

58

Yes, but our nation pays the highest prices for the Rx, so we are paying the lion’s share of the R&D costs. The other countries are quite prosperous and should share in those R&D costs.

59

“Yes, but our nation pays the highest prices for the Rx, so we are paying the lion’s share of the R&D costs.”

Not exactly, and definitely not applicable to generics that are the subject of this thread.

60

Good point, ucb. In fact, that’s true of medical care in general. It does not function like a normal market in a myriad of ways. Trying to treat it as one leads to all kinds of anomalies that just don’t happen in the market for shoes or cars, all too often with tragic results.