Menlo Park, CA—While no news to pharmacists, drastic price hikes for EpiPen have fueled media discussion for months. What have the increases really meant for Medicare and for the older Americans it insures?
A new report from the Henry J. Kaiser Family Foundation documents how much Medicare Part D has spent since 2007 on the autoinjector containing the drug epinephrine, which is used to reverse the effects of severe allergic reactions.
The foundation reports that, since the EpiPen was acquired by Mylan from Merck & Co. in 2007, the list price for a pack of two EpiPens has shot up nearly 550%, from $94 in January 2007 to $609 in May 2016.
“While the EpiPen can be a lifesaver for children with serious food allergies, it is also used to treat life-threatening allergic reactions experienced by the older adults and people with disabilities who are covered by Medicare,” the report points out, adding that the device is covered under Medicare Part D.
According to the analysis, total Medicare Part D spending for the EpiPen increased from $7.0 million in 2007 to $87.9 million in 2014, an increase of 1,151%. The total number of Part D enrollees using the EpiPen also increased over the time period, from nearly 80,000 users in 2007 to more than 211,000 in 2014, but that increase was only 164%.
At the same time, average total Part D spending per EpiPen prescription increased nearly five-fold, from an average of $71 in 2007 to $344 in 2014—a 383% increase. That is a much higher rate than average per capita Part D costs or medical care inflation, according to the Kaiser Family Foundation.
“For example, in 2008, Part D spending per EpiPen prescription increased by 7.4%, more than 3.5 times greater than the increase in total Part D per capita spending (2.0%) and twice the rate of medical care price inflation (3.7%),” report authors point out. “In 2014, Part D spending per EpiPen prescription increased by 34.0%, four times the rate of increase in Part D per capita spending (8.6%) and 14 times larger than the 2.4% increase in medical care price inflation.”
Beneficiaries also took a financial hit, according to the review. Average out-of-pocket spending by Part D enrollees for each EpiPen prescription nearly doubled between 2007 and 2014, from $30 to $56, among enrollees who do not receive Low-Income Subsidies (LIS) under Part D.
“In the aggregate, out-of-pocket spending by all Part D enrollees who used the EpiPen increased more than five-fold between 2007 and 2014, from $1.6 million to $8.5 million, reflecting both an increase in the number of users and price increases for the EpiPen,” according to the report.
Noting that the analysis is based on data available only to 2014, the authors emphasize that their report does not reflect additional EpiPen price increases that have occurred since then. They state, however, that the list price of the EpiPen has increased from $349 in May 2014 to $609 in May 2016, a 74% increase.
“If total Part D spending per EpiPen prescription also increased by 74% between 2014 and 2016, Medicare Part D spending for the EpiPen would have increased from $344 per prescription in 2014 to $600 per prescription in 2016—more than an eight-fold increase since 2007,” study authors posit.
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