The EpiPen debacle may be the shot heard around the world


The Mylan EpiPen debacle may have inadvertently weakened the grip of big pharma on U.S. lawmakers.  Recently, a bill proposed by Senator Bernie Sanders was narrowly rejected by a vote of 52 to 46.  Unexpectedly, 12 Republicans and 1 Independent voted with Senator Sanders in favor of allowing pharmacists and distributors to import cheaper prescription drugs from foreign countries.  The winds of change may finally blow in a bipartisan direction.  U.S. health care needs a revolution; “the shot heard round the world” refers to the opening shots of the American Revolution.  Big pharma is holding American people hostage with exorbitant ransom demands.

Last summer, Mylan Pharmaceuticals, led by CEO Heather Bresch, overplayed their hand and came under fire for a 400 percent price increase in the EpiPen two-pack.  The significant price increase ($600 to $700 for a medication costings pennies) was justified due to the more ergonomic appearance and improved safety of the device.  The motto of big pharma: When encountering limited access, by all means, hike the price of your wares.  Her miscalculation inadvertently incited the war on Big Pharma by angering the public, the media, and the government simultaneously.

Ms. Bresch landed herself in front of the House Oversight and Government Reform Committee on September 21st, in attempts to defend her bold decision, where she insisted the company only profited $100 on each two-pack.  Her salary ballooned from 2.5 million to almost 19 million between 2007 and 2015.  Later that same month, the Centers for Medicare and Medicaid Services (CMS) discovered the EpiPen had been misclassified as a generic drug, making it ineligible for the low rebates Mylan was paying back to Medicaid.  Essentially, Mylan overbilled Medicaid for its life-saving drug resulting in being saddled with a large settlement.

In December 2016, Ms. Bresch took full responsibility for marking up the price of EpiPen.  Ironically, CEO Heather Bresch is the daughter of U.S. Senator Joe Manchin (D-WV). Bresch has had ethical difficulties throughout her illustrious career starting when her father was a governor.  Every decision she makes borders on unscrupulous.  Keeping a stockpile of epinephrine in the public schools was incentivized by federal law.  The EpiPen4Schools program, created by Mylan in 2012, provided free and discounted EpiPens ($112.10) to more than 65,000 schools.  However, in order to qualify for the discount, schools had to agree not to purchase products from any competitors during the year.

Maybe we are witnessing true bipartisanship being ushered into Washington.  The morning of the pharmaceutical bill vote, President Donald Trump accused big pharma of “getting away with murder.”  He stated “there’s very little bidding on drugs,” blaming the harmful influence of the pharmaceutical lobby.  Currently, federal law prohibits our government from negotiating Medicare drug prices with the pharmaceutical companies.  The tide may be turning; four more votes are all that are needed next time.  Rep. Peter Welch (D-VT) has introduced a bill that would allow Medicare negotiation on drug prices.  Prohibiting Medicare from the first right of refusal in regard to price negotiation and medication formulary exclusion absolutely must end.

The Pharmaceutical Research and Manufacturers of America (PhRMA), opposes Medicare negotiation and importation of foreign medications because they “will not ensure prescription drugs entering the U.S. from abroad are safe and effective.”  Who are they kidding?  Have you purchased medications outside the country before?  It is a veritable smorgasbord of brand names, all in English.  It’s almost as if the medications walked across the border.  Big pharma keeps peddling fear and trepidation; however, the tight grip they have had over Washington is indeed loosening.

Those who supported Senator Sanders’ bill should be commended for voting with their conscience as opposed to their pocketbooks.  The 13 courageous GOP and Independent Senators who voted with Sen. Bernie Sanders are: John Boozman (AR), Susan Collins (ME), Ted Cruz (TX), Jeff Flake (AZ), Charles Grassley (IA), Dean Heller (NV), John Kennedy (LA), Curtis King (ME), Mike Lee (UT), John McCain (AZ), Lisa Murkowski (AK), Rand Paul (KY), and John Thune (SD.) It is worthwhile to note, 13 Democratic Senators voted against this bill, however many, including my own Senator from Washington State, Patty Murray, had ties to the pharmaceutical industry.  She received 300K in funding from big pharma during her most recent re-election bid.

The overconfidence of Mylan Pharmaceuticals in support of government and the public for restricting access to life-saving medications for children was “the shot heard round the world.”  In one sweeping move, their CEO violated the trust of the consumer, by bankrupting them, Wall Street, as evidenced by declining share price, the pharmaceutical industry, by exposing their profit-driven manifesto, and most importantly, the federal government and its lawmakers.

Recently, CVS announced it would begin stocking a competitor of EpiPen, Adrenaclick, for $110, a textbook example of free market forces at work.  An epinephrine delivery device has become available for $10 to patients at the largest pharmacy retailer in the nation within six months of Mylan’s’ price misstep.  Most individuals with private insurance now qualify for a manufacturer’s coupon knocking $100 off the price which will be applied right at the register.  The public maelstrom started by the CEO of Mylan not only took a toll on their share price, which tumbled from $54 to $36, but lost the monopoly on schools, pharmacies, and patients at the same time.

When President Ronald Reagan gave his infamous speech, “tear down this wall,” he noticed words of wisdom spray painted upon its structure: “This wall will fall. For it cannot withstand faith; it cannot withstand truth. The wall cannot withstand freedom.”  The wall of Big Pharma has begun to crumble, and it is time to hold feet to the fire.  Four more votes stand between consumers and their freedom to purchase medications in foreign countries for pennies on the dollar.  Mylan showed their true colors and my sincere hope is they can no longer stand in the way of the acquisition of knowledge, truth, and freedom of individuals to manage health for themselves.

Niran S. Al-Agba is a pediatrician who blogs at MommyDoc.  

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