My severe peanut allergy could have cost me my life if I did not have my EpiPen pack by my side. As a young elementary schooler, I was swimming at a friend’s house and grabbed a handful of snacks that her mom had kindly put out for us. Little did I know that the snacks were peanut butter-filled pretzel pockets, which I had never encountered before. I immediately knew something was wrong when my throat began closing. Luckily, I had brought my EpiPen with me that day.
Parents of children with a peanut allergy are in constant fear that they can’t control everything their child eats. Like my own elementary school, many schools have now stopped putting out peanut butter on cafeteria tables or have altogether banned peanut butter in student lunches or snacks. But kids are not always fully aware of the possibility that nuts or nut traces could be in the food they encounter in uncontrolled settings.
Whether it’s a snack pack that “may contain nuts” or “processed in a facility with nuts” like most granola bars or cookies, young kids with the allergy are expected to have the diligence of an adult to know exactly what they are eating and its risks. And families of kids with peanut allergies are expected to have an unlimited supply of EpiPens.
One in 13 kids now are burdened with a severe food allergy—this number has “jumped 50% in the last decade.” These severe allergic reactions consist of anaphylaxis, which is a life-threatening response of the body that swells and closes off airways. Medicine called Epinephrine opens these airways and can save the life of a child who accidentally ate a peanut butter cookie given to them.
Mylan, the drug company who owns the EpiPen epinephrine auto-injector, met exposing backlash in 2016 through a $264 million lawsuit settlement for their product’s price increase. In response to the growing option of generic epinephrine auto-injectors, Mylan moved to monopolize the industry by increasing the EpiPen price by over 400% between 2009 and 2016. One EpiPen costs Mylan under $30 to make, yet families paid over $600 for the lifeline drug that expires annually.
I have always had to rely on my trusty EpiPen pack to save my life in case of an allergic reaction, which is a very real daily possibility. If I accidentally eat something that contains nuts, I know I have my EpiPen at the rescue. But not all families can afford the device.
It is unimaginable to think that parents have to send their kids back to school without severe-allergy medication because they cannot pay the hundreds of dollars for an EpiPen pack that expires within a year. “No one should be forced to weigh costs to obtain life-saving medications such as epinephrine,” one mother contends. “This drug is not a luxury; it’s a lifeline.”
Mylan has taken steps in the right direction since then by creating a cheaper generic version and implementing drug-access programs. However, the company’s scandal exposes a truth behind many other drug companies’ prices: pharmacy benefit managers (PBMs).
PBMs act as drug industry middlemen. Companies like Mylan contract high profits off product sales with PBMs in return for favoritism over other market competitors. These profits are called “rebates” and consisted of half of the price increase on the EpiPen. CEO of Mylan, Heather Bresch, confessed before Congress that “for every $608 EpiPen 2-pack, $334 go to other players in supply chain—middle men, including pharmacy benefit managers, or PBMs.”
Bresch agreed after Mylan’s exposure that there must be a demand for change in this corrupt system of profiteering and cronyism.
Regardless of the actions of insurance and drug companies, educating and preparing patients and their families on how to navigate their pricing options within such a confusing system is an important proactive step.