According to a report in the Washington Examiner, drug maker Mylan lobbied the U.S. Preventive Services Task Force to require insurers to pay the full price of EpiPens by deeming the drug delivery device a preventative measure. Under the Affordable Care Act, health plans must cover preventive services 100% without cost-sharing regardless of whether deductibles have been met. EpiPens are used by people with severe allergies who go into anaphylactic shock. They are not used to prevent anaphylaxis, they treat the symptoms once it occurs. For example, under ACA regulations, a flu shot is a preventive medicine. Once you have the flu, seeing your doctor for Tamiflu would be a treatment, not a prevention.
Earlier this year Mylan came under fire after consumers complained it had increased the price of its epinephrine auto-injector — the EpiPen — about 450% in the past decade. The EpiPen is sold only in twin-packs costing more than $600. An EpiPen cost less than $60 in 2007 when they were still sold individually. With health insurance deductibles rising over the past 10 years, Mylan could no longer conceal its price increases once many consumers were hit with the full price of an EpiPen. Mylan tried alleviate consumer complaints — while protecting its high prices — by shafting insurers and employer plans.
As I’ve said in the past, health care is increasingly experiencing a gold rush, where providers, drug makers and medical device manufacturers do their best to shaft insurers and employers. This occurs because the consumers of medical care (patients) are not the ones who pay for medical care (employers and insurers). Thus, providers of medical goods and services do not maximize revenue by competing on price. Rather, they make money by charging as much as they can and enticing patients to gorge at the health care trough. Patients are willing coconspirators because they pay only about 11 percent of their own medical bills out of pocket, on average. Consumer outrage over EpiPen prices is a good example of why consumers need to be enlisted in the fight against high medical bills.