{"id":2152,"date":"2016-09-12T14:49:11","date_gmt":"2016-09-12T18:49:11","guid":{"rendered":"http:\/\/blogs.nejm.org\/general-medicine\/?p=2152"},"modified":"2016-09-22T11:33:43","modified_gmt":"2016-09-22T15:33:43","slug":"make-epipen-cheap","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/09\/make-epipen-cheap\/","title":{"rendered":"EpiPens Should Be Less Expensive"},"content":{"rendered":"
\"Kashif<\/a>

Kashif Shaikh, MD, is the 2016-17 Chief Resident in Internal Medicine at the University of Central Florida College of Medicine.<\/p><\/div>\n

This basic lifesaving medication\u00a0is cheap to produce.\u00a0It should not be\u00a0a way to make\u00a0a billion dollar profit.\u00a0Should EpiPens\u00a0be inexpensive and available? I say yes,\u00a0and here are my reasons. I am not going to blame Shkreli or Bresch for trying to\u00a0make\u00a0money;\u00a0it’s the\u00a0system of silence and inaction that I blame.\u00a0 Money, power, corruption, and political influence are the key factors that allow big pharma and the individuals who run them to get free publicity and\u00a0 millions of dollars in their pockets.<\/p>\n

 <\/p>\n

\"EpiPen<\/a>

By Intropin (Own work) [CC BY 3.0], via Wikimedia Commons<\/p><\/div>Remember Shkreli\u2019s arrest?\u00a0\u00a0He posted bail of $5 million within 24 hours. Yeah, the same guy who drove the price of Daraprim from $13.50 to $750 a pill had no problem coming up with $5 million in a day. Surprising? No.<\/p>\n

Currently, Shkreli’s company,\u00a0Turing Pharmaceuticals, makes the only FDA-approved pyrimethamine to treat toxoplasmosis. Even though the patent expired long ago, any company who wants to make a generic\u00a0would need considerable time to go through FDA\u2019s approval process. Silence and inaction on drug reform mean that patients\u00a0are now charged 50 times more for their medication.<\/p>\n

When Bresch’s company, Mylan, first bought Epipen in 2007, the price was around $50 for a single pen. Now, it has climbed to $600 for a pack of two!\u00a0Epinephrine is not a new drug. It was\u00a0first isolated\u00a0in 1901, and it is not under patent. It is on the WHO list of essential medications, and\u00a0the wholesale cost in the developing world is between US$0.10 and US$0.95 a vial. In\u00a0Canada,\u00a0Epipens\u00a0cost around $102\u00a0(American) dollars, because\u00a0Canada regulates drug prices.<\/p>\n

\"first<\/a>

By Owain Davies (Own work) [CC BY-SA 3.0], via Wikimedia Commons<\/p><\/div>The Epipen autoinjector is<\/em> patented.\u00a0But, how much does it cost to make an autoinjector? I mean, it is not made of gold or platinum!\u00a0\u00a0Now,\u00a0Mylan\u00a0promises a\u00a0cheaper generic for the U.S. market. This is the\u00a0recent trend in pharmaceuticals \u2014\u00a0to raise prices (“temporarily”) with a promise of a future generic. Everyone\u00a0 quietly pays the\u00a0\u00a0“temporary” higher price,\u00a0because “the generic is coming.”<\/p>\n

However, the FDA takes a long time\u00a0to approve generic medications and devices. Teva failed to obtain regulatory approval for its epinephrine-delivery device, and Sanofi recalled its autoinjector for incorrect dosage delivery. So Mylan\u00a0alone sells Epipens and can\u00a0 increase the price without any competition. One might say that this is exploitation of a basic human need to\u00a0obtain a life-saving medication \u2014\u00a0a medication that\u00a0has been produced for almost\u00a0100 years.<\/p>\n

\"FDA<\/a>

See page for author [Public domain], via Wikimedia Commons<\/p><\/div>Drug and device patents allow monopolies in the pharmaceutical industry: An average patent is enforced for 12 to 15\u00a0years.\u00a0Although drug regulation obviously is important for patient safety,\u00a0drug prices\u00a0should be regulated, and approvals of generics should be prioritized. Right now, federal law prohibits<\/em> Medicare from negotiating drug prices. We need legislation\u00a0that limits the ability of pharmas to manipulate the system.<\/p>\n

 <\/p>\n

\"drug<\/a>

By Julphar.uae (Own work) [CC BY-SA 4.0], via Wikimedia Commons<\/p><\/div>There is no transparency in the drug manufacturing costs, and a recent\u00a0analysis, reviewed by NEJM Journal Watch,\u00a0suggests that development costs do not explain the costs of patent drugs (Why Do Prescription Drugs Cost So Much?)<\/a>. In reality, the silence and inaction around drug pricing allows pharmas to charge “whatever the market will bear.” It is unfair to the general public, because medicine is not a choice, but a need.\u00a0Silence and inaction are unacceptable responses.<\/p>\n","protected":false},"excerpt":{"rendered":"

This basic lifesaving medication\u00a0is cheap to produce.\u00a0It should not be\u00a0a way to make\u00a0a billion dollar profit.\u00a0Should EpiPens\u00a0be inexpensive and available? I say yes,\u00a0and here are my reasons. I am not going to blame Shkreli or Bresch for trying to\u00a0make\u00a0money;\u00a0it’s the\u00a0system of silence and inaction that I blame.\u00a0 Money, power, corruption, and political influence are the […]<\/p>\n","protected":false},"author":1276,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[17,99,31,41],"class_list":["post-2152","post","type-post","status-publish","format-standard","hentry","category-clinical-implications-of-research","tag-chief-resident","tag-drug-prices","tag-patient-care","tag-technology"],"yoast_head":"\nEpiPens Should Be Less Expensive - Insights on Residency Training<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/09\/make-epipen-cheap\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"EpiPens Should Be Less Expensive\" \/>\n<meta property=\"og:description\" content=\"This basic lifesaving medication\u00a0is cheap to produce.\u00a0It should not be\u00a0a way to make\u00a0a billion dollar profit.\u00a0Should EpiPens\u00a0be inexpensive and available? I say yes,\u00a0and here are my reasons. I am not going to blame Shkreli or Bresch for trying to\u00a0make\u00a0money;\u00a0it’s the\u00a0system of silence and inaction that I blame.\u00a0 Money, power, corruption, and political influence are the […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/09\/make-epipen-cheap\/\" \/>\n<meta property=\"og:site_name\" content=\"Insights on Residency Training\" \/>\n<meta property=\"article:published_time\" content=\"2016-09-12T18:49:11+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2016-09-22T15:33:43+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2016\/08\/Kashif-Shaikh.jpg\" \/>\n<meta name=\"author\" content=\"Kashif Shaikh, MD\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Kashif Shaikh, MD\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/09\/make-epipen-cheap\/\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/09\/make-epipen-cheap\/\",\"name\":\"EpiPens Should Be Less Expensive - Insights on Residency Training\",\"isPartOf\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\"},\"datePublished\":\"2016-09-12T18:49:11+00:00\",\"dateModified\":\"2016-09-22T15:33:43+00:00\",\"author\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/2d154451c82e25bd3ca6b66def3c32c2\"},\"breadcrumb\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/09\/make-epipen-cheap\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/09\/make-epipen-cheap\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/09\/make-epipen-cheap\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/blogs.nejm.org\/general-medicine\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"EpiPens Should Be Less Expensive\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/\",\"name\":\"Insights on Residency Training\",\"description\":\"Observation of residents across diverse medical specialties\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/blogs.nejm.org\/general-medicine\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/2d154451c82e25bd3ca6b66def3c32c2\",\"name\":\"Kashif Shaikh, MD\",\"description\":\"Kashif\u2019s inspiration in life comes from his family members who are educators, engineers, and physicians settled across England, the United States, Canada, and Pakistan. After attending the Aga Khan University Medical College in the coastal city of Karachi, he moved to Houston to become an Internal Medicine resident at the University of Texas Health Science Center. He decided to pursue hospital medicine at a health-underserved area in Central Florida and became a Chief Resident at the new Internal Medicine Residency Program at the University of Central Florida College of Medicine. He is a Harry Potter fan who grew up reading Jane Austin and Emily Bronte. He played chess and badminton avidly as extra-curricular activities in school. He enjoys listening to Billie Holiday, Ella Fitzgerald, Chopin, Beethoven, and Bach. He is a car enthusiast and loves road trips to nearby beaches in sunny Florida. Some of his interests include history, museums, art galleries, live theater, short films, historic cities, documentaries, charity events, and current affairs. His future plans include a rheumatology fellowship, a career in academic medicine, and charity and volunteer work.\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/author\/kshaikh\/\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"EpiPens Should Be Less Expensive - Insights on Residency Training","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/09\/make-epipen-cheap\/","og_locale":"en_US","og_type":"article","og_title":"EpiPens Should Be Less Expensive","og_description":"This basic lifesaving medication\u00a0is cheap to produce.\u00a0It should not be\u00a0a way to make\u00a0a billion dollar profit.\u00a0Should EpiPens\u00a0be inexpensive and available? I say yes,\u00a0and here are my reasons. I am not going to blame Shkreli or Bresch for trying to\u00a0make\u00a0money;\u00a0it’s the\u00a0system of silence and inaction that I blame.\u00a0 Money, power, corruption, and political influence are the […]","og_url":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/09\/make-epipen-cheap\/","og_site_name":"Insights on Residency Training","article_published_time":"2016-09-12T18:49:11+00:00","article_modified_time":"2016-09-22T15:33:43+00:00","og_image":[{"url":"http:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2016\/08\/Kashif-Shaikh.jpg"}],"author":"Kashif Shaikh, MD","twitter_misc":{"Written by":"Kashif Shaikh, MD","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/09\/make-epipen-cheap\/","url":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/09\/make-epipen-cheap\/","name":"EpiPens Should Be Less Expensive - Insights on Residency Training","isPartOf":{"@id":"https:\/\/blogs.nejm.org\/general-medicine\/#website"},"datePublished":"2016-09-12T18:49:11+00:00","dateModified":"2016-09-22T15:33:43+00:00","author":{"@id":"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/2d154451c82e25bd3ca6b66def3c32c2"},"breadcrumb":{"@id":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/09\/make-epipen-cheap\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/09\/make-epipen-cheap\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/09\/make-epipen-cheap\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.nejm.org\/general-medicine\/"},{"@type":"ListItem","position":2,"name":"EpiPens Should Be Less Expensive"}]},{"@type":"WebSite","@id":"https:\/\/blogs.nejm.org\/general-medicine\/#website","url":"https:\/\/blogs.nejm.org\/general-medicine\/","name":"Insights on Residency Training","description":"Observation of residents across diverse medical specialties","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.nejm.org\/general-medicine\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/2d154451c82e25bd3ca6b66def3c32c2","name":"Kashif Shaikh, MD","description":"Kashif\u2019s inspiration in life comes from his family members who are educators, engineers, and physicians settled across England, the United States, Canada, and Pakistan. After attending the Aga Khan University Medical College in the coastal city of Karachi, he moved to Houston to become an Internal Medicine resident at the University of Texas Health Science Center. He decided to pursue hospital medicine at a health-underserved area in Central Florida and became a Chief Resident at the new Internal Medicine Residency Program at the University of Central Florida College of Medicine. He is a Harry Potter fan who grew up reading Jane Austin and Emily Bronte. He played chess and badminton avidly as extra-curricular activities in school. He enjoys listening to Billie Holiday, Ella Fitzgerald, Chopin, Beethoven, and Bach. He is a car enthusiast and loves road trips to nearby beaches in sunny Florida. Some of his interests include history, museums, art galleries, live theater, short films, historic cities, documentaries, charity events, and current affairs. His future plans include a rheumatology fellowship, a career in academic medicine, and charity and volunteer work.","url":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/author\/kshaikh\/"}]}},"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/posts\/2152","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/users\/1276"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/comments?post=2152"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/posts\/2152\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/media?parent=2152"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/categories?post=2152"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/wp-json\/wp\/v2\/tags?post=2152"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}