The private sector health crisis

Not all of the problems with health care in the United States have to do with insurance exchanges or Medicare/Medicaid reimbursement or the Affordable Care Act (Obamacare) — at least not initially. But we’ve seen some startling examples of why they will inevitably intersect.

Not long ago we had the saga of Turing Pharmaceuticals CEO Martin Shkreli, who last fall earned the title of “most hated man in America” for raising the price of Daraprim, a drug used by AIDS and cancer patients, from $13.50 to $750 … per pill.

The numbers involving Mylan NV’s EpiPen aren’t quite as extreme, but they’re more than appalling enough. And it’s a medicine that can quite literally mean the difference between life and death at a moment’s notice.

The drug involved is epinephrine (adrenaline), which can counteract a life-threatening allergic reaction to insect stings or certain foods, a reaction that often takes the form of anaphylactic suffocation when the airway swells shut.

Mylan NV’s version of the drug is a convenient portable injector called the EpiPen, which people with such allergies can keep with them at all times. And according to reports by National Public Radio and other news outlets, the wholesale price of a single EpiPen has risen from $47 in 2007 (Mylan bought rights to the product in 2008) to $284 now.

“But consumers can no longer buy a single pen,” NPR reported, “so the retail price to fill a prescription today at Walgreens is about $633, according to GoodRX.”

U.S. lawmakers have responded with outrage. Among them are Sen. Richard Blumenthal, D-Conn., who wrote in a letter to the company, "I demand that Mylan take immediate action to lower the price of EpiPens for all Americans that rely on this product for their health and safety." Sen. Charles Grassley, R-Iowa, has called for an investigation; Sen. Amy Klobuchar, D-Minn., suggested the manufacturer might be subject to antitrust law scrutiny.

It will be interesting to see just how sincere these expressions of outrage are and how much pressure there actually will be. The Mylar CEO — whose earnings, according to the New York Times, have soared from $2.7 million in 2007 to $18.2 million last year — is Heather Bresch. That’s Heather Manchin Bresch, daughter of Sen. Joe Manchin, D-W.Va. Though corporate executives have often been put on the hot seat by Congress before, NPR raised the legitimate question of “whether the angry senators will be as inclined to be as aggressive with the daughter of one of their colleagues.”

In a Monday statement, Mylar said some 80 percent of insured EpiPen users get it free. That doesn’t help the other 20 percent whose insurance doesn’t cover it, not to mention the millions of uninsured. And even with the most comprehensive coverage, an exponentially escalating cost is unsustainable.

There was also this from Mylar: "Ensuring access to epinephrine — the only first-line treatment for anaphylaxis — is a core part of our mission."

The definition of “access” embedded in that sentence is straight out of Orwell.