Eddie Maza ’18 was two years old when he and his family discovered he was severely allergic to nuts and sesame. Unfortunately, he learned it the hard way: by eating tahini, a sesame-based condiment.
Maza was rushed to the hospital, joining the approximately 300,000 children who visit the hospital due to a food allergy each year, according to estimates from the Centers for Disease Control.
Today, Maza is supposed to carry an EpiPen, an auto-injector that delivers epinephrine to individuals suffering from anaphylaxis — an allergic reaction that can cause blood pressure to drop and the throat to swell up or even close. An injection of the drug staves off anaphylaxis long enough for an individual to reach a hospital. But should Maza accidentally ingest nuts or sesame, he will have a problem: He does not carry an EpiPen. The makers of EpiPens, a pharmaceutical company called Mylan, have slowly increased the price since acquiring the product in 2007. The most recent price hike — “the most drastic,” according to Maza — set the market price around $600 for a box of two EpiPens, a sixfold increase since Mylan began manufacturing the product nine years ago.
“Last time I bought them they were between $150 and $200 each, and even that is prohibitively expensive,” Maza said. “It’s really awful. I don’t have an EpiPen right now that’s not expired, because they’re too expensive … It feels silly to pay $600 for something I’ll ultimately throw out.”
Fortunately for Maza and others who suffer from severe allergies, both Yale and the U.S. government are prepared to make adjustments in order to ensure those who need epinephrine auto-injectors can afford them.
Connecticut Sen. Richard Blumenthal LAW ’73, in conjunction with Minnesota Sen. Amy Klobuchar ’82, called for an immediate antitrust investigation into Mylan on Sept. 6. The following day, the Senate announced the formation of a subcommittee tasked with conducting a preliminary inquiry into EpiPen pricing, and on Wednesday, a Mylan spokesperson confirmed in a press release that Mylan CEO Heather Bresch will testify in a congressional hearing next Wednesday.
Blumenthal and Klobuchar particularly took issue with Mylan’s “EpiPen4Schools” program, which provides discounted EpiPens to primary and secondary schools. However, participating schools must sign a contract promising not to purchase any products from Mylan’s competitors for 12 months.
“Providing discounts on the condition that the customer not purchase a competitor’s goods is the kind of conduct that can violate the antitrust laws when taken by a monopolist, and in Mylan’s case, this may be a direct violation of Section 5 [of the Federal Trade Commission Act],” Blumenthal and Klobuchar wrote in an open letter to Bresch. “In the past, enforcement actions have been initiated, at least in part, in response to conditional discounts similar to those offered to schools by Mylan.
Blumenthal’s concern for consumer protection is not new. As a senator, he has called for similar antitrust investigations into the airline industry and Google in the last year, and previously as Connecticut Attorney General, he took on a case against Smith & Wesson in 2000.
Since it is not eligible to participate in Mylan’s “EpiPen4Schools” program, the University has mostly absorbed the cost of the EpiPens, according to the University’s Director of Pharmacy and Medication Management Peter Steere.
Steere explained that Yale classifies its drugs according to prevalence: generic or multi-sourced drugs are considered Tier One, while Tier Two is composed of branded products that lack generic alternatives. Tier Three drugs are drugs that also have a Tier One generic or have a preferred version classified as a Tier One or Tier Two drug.
Yale offers two different types of epinephrine auto-injectors. One version — a “slightly more affordable” version — is considered Tier One, while EpiPens are considered Tier Two.
As the Tier One auto-injector is not prescribable to children, the Tier Two “EpiPen Jr.” does not have an affordable alternative. If members of the Yale health plan need to buy either one, the health plan absorbs the cost.
Even though Yale Health ensures that people who need epinephrine auto-injectors can access them, Steere cautioned against the precedent Mylan has set.
“The dilemma is making sure we can afford new treatments as they come along, and they’re extraordinary expensive,” Steere said. “We have hope that the more traditional and longstanding products we use will stay cost-effective, but when something like this happens, it shows how vulnerable anyone buying and selling medication is.”