Mylan and epi pen

[Mman]

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I am again reminded why so very, very, very few anesthesiologists have ever heard of this forum. Fortunately, I know that most anesthesiologists have a more robust grasp of economics and the reality of this world. Hopefully your residents will learn much from your styles of discussion on this forum. Hopefully they will learn the world does not respond to battery as an argument mechanism vs. a meaningful discussion.

For any resident who wonders whether your attendings have any awareness of their flawed skills and thinking, I refer you to this seminal manuscript that is titled, "Unskilled and unaware of it: how difficulties in recognizing one's own incompetence lead to inflated self-assessments." Your initial impressions of your attendings is very likely correct.
http://www.ncbi.nlm.nih.gov/pubmed/10626367

No offense, but you come off as a bit unaware in this thread. Whether you lean left or right on the political spectrum, there is an issue with pharmaceutical companies jacking up prices on old generic drugs to insane levels to gouge patients that need them. If you can't understand why people disagree with your take, well that's on you. Insulting posters and insinuating they are the ones that give our specialty a bad rap is about as juvenile as it gets. I would hope you could open your eyes and your ears and try to take in an opposing viewpoint with a little more tact.

I'm as capitalistic as it gets and even I have a problem with the pricing of Epi Pens.

I'm thinking of starting a new service in my neighborhood and having everybody pay me $250 a year within a mile radius and if they have an anaphylactic reaction I'll come over and shoot them up with some vials of epi I have on hand. Cheaper than epi pen and you get to have an actual doctor deliver the med. 🙂

 

[Mman]

What did you contribute to the discussion other than saying anesthesiologists are nurses and doctors are stupid? Honestly, looking back at your contributions made me realize you had nothing to contribute. Your argument can be summed up as: we don't know what it takes to keep a company afloat and doctors are stupid. Really not much substance there.

Except for it being a public company so we know every detail of their financing

 

[Planktonmd]

These forums occasionally attract some very "Eccentric" characters and I think we are witnessing the birth of one of those!
Anyone who claims to be a physician and then argues in the defense of the outrageously corrupt and inhumane practices of the blood sucking pharmaceutical enterprise, is either not a physician (most likely), or just another one of those mental institute residents that seem to be attracted to SDN.

 

[gtb]

What did you contribute to the discussion other than saying anesthesiologists are nurses and doctors are stupid? Honestly, looking back at your contributions made me realize you had nothing to contribute. Your argument can be summed up as: we don't know what it takes to keep a company afloat and doctors are stupid. Really not much substance there.

Singularly, I believe the most significant contribution I made to this forum is ensuring any resident reading this post is aware of the manuscript: http://www.ncbi.nlm.nih.gov/pubmed/10626367 "Unskilled and unaware of it: how difficulties in recognizing one's own incompetence lead to inflated self-assessments."
Sadly, it seems the value and usefulness of this particular forum passed with the passing of UTSouthwestern. I promise, I will not trespass on your forum again. Out.

 

[Mman]

Singularly, I believe the most significant contribution I made to this forum is ensuring any resident reading this post is aware of the manuscript: http://www.ncbi.nlm.nih.gov/pubmed/10626367 "Unskilled and unaware of it: how difficulties in recognizing one's own incompetence lead to inflated self-assessments."
Sadly, it seems the value and usefulness of this particular forum passed with the passing of UTSouthwestern. I promise, I will not trespass on your forum again. Out.

sadly a lack of self reflection was apparently not found if/when you read that in regards to your own self-assessment

 

[gotname]

New and expanding regulations for pharmaceutical manufacturers, new and expanding costs of employing individuals manufacturing the products, and ever expanding legal costs for any producer of any product that actually saves lives. Why are people posting on this subject so incredibly comfortable achieving an annual salary in excess of $250K (low end for anesthesiologists), but complain about a manufacturer of product, enabling anesthesiologists to actually safely practice their profession, charging enough money to actually pay decent salaries to their employees? These companies have armies of engineers, Phd scientists, manufacturing specialists, an ever expanding clinical regulatory staff, along with the numerous other employees necessary to make any company function. Plus, they are required to spend millions, millions of dollars on legal costs completely unrelated to normal manufacturing and distribution costs. And of course, how many of you, deriding the profit making of these companies, will intentionally put your retirement savings into a company that is intentionally not for profit? I get the emotional appeal of your arguments, but I hope that your clinical practice is not so emotionally based and instead relies on practical evidence and reality.

Disturbing. No matter how many employees they have or need, how much money they have or need to spend for business...greed is not a required to make a company function.

These executives are acquiring a substantial profit, not for the interest of company development but for themselves. This practice is not exclusive to Mylan but this is one of the most repulsive cases.

And your comparison - what you seemingly meant was absurd but let's look at access. If the services of one doctor are not affordable, there are usually other doctors or payment options etc. However, there is just the epipen. A syringe can be a disaster depending on where you are when you experience anaphylaxis. I've experienced anaphylaxis enough times and in some inconvenient places to know that I'm glad I have an auto injector. Going to a doctor for a shot is not very realistic because anaphylaxis is not going to occur at your convenience.

Epipens save lives. Many others and I are paying $600 for 2pens because anaphylaxis can kill. We have no choice but these executives do. They choose more money because they can.

They're jerks.

 

[Spikebd]

Mylan CEO Heather Bresch is also a Clinton Foundation Supporter, having donated between $100,000 - $250,000 sometime in 2009. I know most if not all politicians take bribes but Ms. Clinton is so obviously crooked it's outrageous anyone could support her. It's a racket and will continue to get worse.

 

[PainDrain]

Has anyone heard the latest from the CEO? She is calling this, the astronomical price hike of the epi pen, a result of the "healthcare crisis" present in the US. She is so FOS. She is simply looking for some way out of this PR disaster and blaming the system seems to be her next move.

 

[Spikebd]

GTB doesn't understand that for many corporations the only way to secure profits is to hire family members of Senators and other Congressmen, then tell them to write the rules in their favor.

 

[Spikebd]

Also, why is it being taught that physicians can't take pens from pharmaceutical companies but the secretary of state of the entire nation can take bribes >$100,000?

 

[PainDrain]

Also, why is it being taught that physicians can't take pens from pharmaceutical companies but the secretary of state of the entire nation can take bribes >$100,000?

Bribery was made legal by the Citizens United ruling. No going back now.

 

[Spikebd]

Bribery was made legal by the Citizens United ruling. No going back now.

That ruling was decided in 2010 and she took these Mylan bribes in 2009. I'm glad you pointed out how hypocritical she is too.

 

[GravelRider]

Bribery was made legal by the Citizens United ruling. No going back now.

Citizens United reminds me of the marijuana laws. Marijuana was decriminalized for years in many areas and now we are seeing laws making it legal. Bribery has been decriminalized for decades in the United States and the Citizens United ruling effectively legalized it.

 

[BLADEMDA]

EpiPens cost just several dollars to make. Customers pay more than $600 for them
http://www.cnbc.com/2016/08/25/epip...omers-pay-more-than-600-dollars-for-them.html

Dan Mangan | @_DanMangan

64
COMMENTSJoin the Discussion

 

[BLADEMDA]

 

[BLADEMDA]

 

[sigrhoillusion]

There's a special place in Hell for people like her and Skreli(sp?)...

 

[WholeLottaGame7]

New and expanding regulations for pharmaceutical manufacturers, new and expanding costs of employing individuals manufacturing the products, and ever expanding legal costs for any producer of any product that actually saves lives. Why are people posting on this subject so incredibly comfortable achieving an annual salary in excess of $250K (low end for anesthesiologists), but complain about a manufacturer of product, enabling anesthesiologists to actually safely practice their profession, charging enough money to actually pay decent salaries to their employees? These companies have armies of engineers, Phd scientists, manufacturing specialists, an ever expanding clinical regulatory staff, along with the numerous other employees necessary to make any company function. Plus, they are required to spend millions, millions of dollars on legal costs completely unrelated to normal manufacturing and distribution costs. And of course, how many of you, deriding the profit making of these companies, will intentionally put your retirement savings into a company that is intentionally not for profit? I get the emotional appeal of your arguments, but I hope that your clinical practice is not so emotionally based and instead relies on practical evidence and reality.

Not sure if you're one of "those people" that claim to leave a thread and then hang around for awhile, or if you actually put your money where your mouth is, but if it's the former, your argument is terribly flawed.

This is like saying if your electric company was bought out and the new company immediately jacked your bill up 800%, you'd be like "good for them, they have a lot of expenses they need to cover, plus they need to make a profit, too!"

Or would you be like, "WTF, they are delivering the exact same product they were last year, this is f***ing ridiculous, where's the BBB?"

If it's the first response, you are either in the 0.001% or you're just totally FOS, which already seems up for debate given some of your subsequent posts.

 

[Random Anesthesiologist]

Mylan also makes remi. Dammit.

This is cronyism at its worst. Other companies attempted bona fide competition and were shot down by the FDA. Thanks daddy Senator.

 

[chessknt]

I have found it amusing that the media and Congress have completely avoided the fda as a source of these monopolies as well. Maybe if the fda wasn't such an expensive pain in the ass we would have more choices and they wouldn't cost so much.

 

[deepstate2016]

I have found it amusing that the media and Congress have completely avoided the fda as a source of these monopolies as well. Maybe if the fda wasn't such an expensive pain in the ass we would have more choices and they wouldn't cost so much.

Oh sweet Jesus, the FDA's only job for the last twenty years has been to lube it up for everyone. It sure has he'll not been protecting the public.

 

[Sardinia]

This country is a joke. Good to know that Mylan's lobbying presence in Washington wasn't affected by its move to the Netherlands. God knows how much in taxpayer money was used to offset costs for this p.o.s. company.

But she also acknowledged that high retail prices of EpiPens in the United States effectively subsidize the cost of the devices when they are sold in Europe, at just $100 or $150. Many of the countries there have government-run health-care systems that limit drug prices charged by manufacturers, unlike the U.S.

"We do subsidize the rest of the world... and as a country we've made a conscious decision to do that," Bresch said. "And I think the world's a better place for it."

 

[fakin' the funk]

Confused on two things:

1) Why isn't the Mylan CEO being shamed as "Pharma Broad"
2) Why aren't there competitors who (presumably) would be willing to sell for < $300/dose?

 

[Onefellswoop87]

Confused on two things:

1) Why isn't the Mylan CEO being shamed as "Pharma Broad"
2) Why aren't there competitors who (presumably) would be willing to sell for < $300/dose?

She is. I've seen multiple non-mainstream media articles on social referring to her as "Pharma Sis"

I've also heard you can write a prescription for epinephrine auto-injection (instead of EpiPen) for the generic. It's still a few hundred bucks but not $600. Unfortunately EpiPen is common vernacular, kinda like Xerox for copy machine or Klenex instead of tissues.

 

[deleted162650]

She is. I've seen multiple non-mainstream media articles on social referring to her as "Pharma Sis"

I've also heard you can write a prescription for epinephrine auto-injection (instead of EpiPen) for the generic. It's still a few hundred bucks but not $600. Unfortunately EpiPen is common vernacular, kinda like Xerox for copy machine or Klenex instead of tissues.

You shouldn't have to do that when writing a script. Just about every pharmacy will by default give an equivalent generic unless you specifically instruct them to give the name brand in your script.

 

[GravelRider]

You shouldn't have to do that when writing a script. Just about every pharmacy will by default give an equivalent generic unless you specifically instruct them to give the name brand in your script.

The issue that has been cited here is that pharmacists don't have the authority to substitute a different device. Since the competitor brand has a different auto-injector mechanism, a pharmacist can't automatically substitute it. With all the press, hopefully docs have realized this and have changed their practice accordingly.

 

[pgg]

The issue that has been cited here is that pharmacists don't have the authority to substitute a different device. Since the competitor brand has a different auto-injector mechanism, a pharmacist can't automatically substitute it. With all the press, hopefully docs have realized this and have changed their practice accordingly.

Interesting, back when I had my own Rx pads there was a box to check if I didn't want the pharmacy to have the discretion to substitute a generic.

Seems ridiculous that an autoinjector device that's decades old (how long has the military had atropine and 2PAM autoinjectors?) could be encumbered by any kind of patent today.

 

[pharmer9911]

Reviving the thread due to the Congressional hearing:

I am a pharmacist.

#1
It's quite safe to assume we are all healthcare providers here. We should stick together and support our roles in the healthcare team. We shouldn't be attacking each other's professions or making personal attacks on a hopefully more professional forum. Instead we can combine our expertise and learn from the situation better. Furthermore, we have many more important battles with other non-healthcare personnel that we all have had to deal with that have trampled over our profession: the number crunchers, the insurers, pharmacy benefit managers (PBM's), and maybe the manufacturer (because I assume very few have experience in that department here but anyone with insight on it would be great)

#2
Congressman Carter was the only member with a healthcare background. He is a pharmacist and had some important points but then digressed to too many baseless/uneducated criticisms. It would have been better if he focused on his actual points about the elements of the drug pricing or wholesale price. His most important point was the pricing breakdown. $608 (price) - $274 (Mylan) = $334 (others). The bulk of the money goes to the four mentioned parties: insurers, PBM's, wholesalers, and pharmacists. The insurer and PBM's are primarily as I understand it, the middlemen just crunching numbers who making billions and billions. They set the unwavering contracts and payments and take a big piece of the profit. They are clouded in mystery and like they mentioned, there is no transparency. What is their share? And their profit? Here is what I could find on the internet:

ESTIMATED GROSS PROFIT PER $600 EPIPEN 2-PACK:
MYLAN $274.
INSURER $249.
PBM $40.
PHARMACIST $27.
WHOLESALER $10.
SOURCE: PEMBROKE CONSULTING
http://www.nbcnews.com/business/consumer/industry-insiders-estimate-epipen-costs-no-more-30-n642091

#3
The rest of Congress did not seem to really know what they were talking about. The most extreme lack of knowledge was probably when Congressman Clay seemed to confuse anaphylactic shock with seizures (although it can happen rarely).

#4
Congress should have invited an insurer, PBM, pharmacist, and wholesaler to the group.

#5
CEO Heather Bresch did not seem to handle the questions very well. Chairman Chaffetz kept going on about $50-$100 not adding up to the $274 profit. Bresch should have clarified that that was the consumers CO-PAY and not their out-of-pocket-no-insurance-cash payment. A CEO making $18m doesn't seem too extravagant to me especially running a $11b company with 40,000 employees. It seems quite low actually.

#6
EpiPen actually comes out about $1 a day if you divide $600 / 18 months expiration = $33 a month. Perhaps people can cut back on life's other necessities like StarBucks, iPhones, iPads, etc?

In conclusion, I believe the biggest problem is with the insurers and PBM.

 

[waterbottle10]

I mean this country is pretty corrupt, so these type of things happen all the time. Idk if we'll ever be able to fix it since the lawyers and politicians make the rules and these companies got their connections. they don't give away so much $$ to politicians for fun

 

[Pooh & Annie]

Reviving the thread due to the Congressional hearing:

I am a pharmacist.

#1
It's quite safe to assume we are all healthcare providers here. We should stick together and support our roles in the healthcare team. We shouldn't be attacking each other's professions or making personal attacks on a hopefully more professional forum. Instead we can combine our expertise and learn from the situation better. Furthermore, we have many more important battles with other non-healthcare personnel that we all have had to deal with that have trampled over our profession: the number crunchers, the insurers, pharmacy benefit managers (PBM's), and maybe the manufacturer (because I assume very few have experience in that department here but anyone with insight on it would be great)

#2
Congressman Carter was the only member with a healthcare background. He is a pharmacist and had some important points but then digressed to too many baseless/uneducated criticisms. It would have been better if he focused on his actual points about the elements of the drug pricing or wholesale price. His most important point was the pricing breakdown. $608 (price) - $274 (Mylan) = $334 (others). The bulk of the money goes to the four mentioned parties: insurers, PBM's, wholesalers, and pharmacists. The insurer and PBM's are primarily as I understand it, the middlemen just crunching numbers who making billions and billions. They set the unwavering contracts and payments and take a big piece of the profit. They are clouded in mystery and like they mentioned, there is no transparency. What is their share? And their profit? Here is what I could find on the internet:

ESTIMATED GROSS PROFIT PER $600 EPIPEN 2-PACK:
MYLAN $274.
INSURER $249.
PBM $40.
PHARMACIST $27.
WHOLESALER $10.
SOURCE: PEMBROKE CONSULTING
http://www.nbcnews.com/business/consumer/industry-insiders-estimate-epipen-costs-no-more-30-n642091

#3
The rest of Congress did not seem to really know what they were talking about. The most extreme lack of knowledge was probably when Congressman Clay seemed to confuse anaphylactic shock with seizures (although it can happen rarely).

#4
Congress should have invited an insurer, PBM, pharmacist, and wholesaler to the group.

#5
CEO Heather Bresch did not seem to handle the questions very well. Chairman Chaffetz kept going on about $50-$100 not adding up to the $274 profit. Bresch should have clarified that that was the consumers CO-PAY and not their out-of-pocket-no-insurance-cash payment. A CEO making $18m doesn't seem too extravagant to me especially running a $11b company with 40,000 employees. It seems quite low actually.

#6
EpiPen actually comes out about $1 a day if you divide $600 / 18 months expiration = $33 a month. Perhaps people can cut back on life's other necessities like StarBucks, iPhones, iPads, etc?

In conclusion, I believe the biggest problem is with the insurers and PBM.

Ok. But Mylan chose the price and desired profits, not the insurers, not the wholesalers or "PBM". What followed were tens of millions in salary increases for the CEO and upper-levels, some of whom were already making tens of millions.

Everyone else involved is getting richer off the price hike too. But they didn't decide to gouge the public to do it. Not that they all mind that part.

And the attacks on Mylan aren't necessarily on the industry, they're on a greedy company. So yes we should "stick together" when we're trying to do the right thing. But I'm not interested in "sticking" with people like this who hurt the reputations of EVERYONE in healthcare.

 

[doctalaughs]

Ok. But Mylan chose the price and desired profits, not the insurers, not the wholesalers or "PBM". What followed were tens of millions in salary increases for the CEO and upper-levels, some of whom were already making tens of millions.

Everyone else involved is getting richer off the price hike too. But they didn't decide to gouge the public to do it. Not that they all mind that part.

And the attacks on Mylan aren't necessarily on the industry, they're on a greedy company. So yes we should "stick together" when we're trying to do the right thing. But I'm not interested in "sticking" with people like this who hurt the reputations of EVERYONE in healthcare.

Did mylan disclose how much it costs them to manufacture each epipen including marketing and acquisition of the injector patent? Clearly there was no R&D since they bought it from someone else.

So if they are making 274 dollars profit and it cost them 80 cents per 2-pack that is pretty egregious price-gouging.

And how much skill does it take for the CEO to decide to jack up the price 600 percent and then take home huge bonuses. I think everyone is pissed because clearly Mylan isnt doing any ground breaking discovery to benefit patients. They are merely exploiting a monopoly created by crooked lobbying and nepotism.


Sent from my iPhone using SDN mobile

 

[WholeLottaGame7]

#6
EpiPen actually comes out about $1 a day if you divide $600 / 18 months expiration = $33 a month. Perhaps people can cut back on life's other necessities like StarBucks, iPhones, iPads, etc?

You more or less had me up until here. This makes no sense and is totally out of context. I think I used this analogy in another thread, but if your water bill went from $20/mo to $120/mo overnight and you were receiving the exact same service, would you be like, "Well, it IS only $4 a day, I can just cut back on X, those utility company CEOs need to eat, too."

The point is, I don't think the Mylan executives were out on the streets begging for scraps when the EpiPens were $100 a pop. And I doubt they are using their newfound windfall for the betterment of science and mankind.

 

[sigrhoillusion]

You more or less had me up until here. This makes no sense and is totally out of context. I think I used this analogy in another thread, but if your water bill went from $20/mo to $120/mo overnight and you were receiving the exact same service, would you be like, "Well, it IS only $4 a day, I can just cut back on X, those utility company CEOs need to eat, too."

The point is, I don't think the Mylan executives were out on the streets begging for scraps when the EpiPens were $100 a pop. And I doubt they are using their newfound windfall for the betterment of science and mankind.

Yea, it's just $1/day... It's like comparing a life saving drug to some crappy life insurance that your grandmother bought off TV... or that non-stick pan from the infomercials.

I can see it now...

We have this BRAND NEW (ok well maybe it's not brand new...) product called the EpiPen!!! If you bought it from the stores it would be $1000, but we won't make you pay $1000... not even $800... maybe $700...? NO WAY!!! If you call in to buy this life saving medicine, you can buy the EpiPen for the amazing low price of 6 easy payments of $99!!!! And this drug lasts 18 MONTHS!!! That's only a $1/day!!!! And if you call within the next 30 minutes we will throw in Stoelting's Anesthesia absolutely FRRREEEEEEEEEE!!!!