
It Costs $30 to Make a DIY EpiPen - Halienja
https://www.technologyreview.com/s/602422/it-costs-30-to-make-a-diy-epipen-and-heres-the-proof
======
googamooga
Medicine is probably the second best place after military where we can observe
how greed and corruption are literally killing people.

I'm living in Russia and recently have been involved in medical devices market
here. The local market for cardiology stents (little springs they insert non-
surgically into your heart to remove artery clogging and prevent heart attack
or stroke) has been long occupied by the three US companies. The Russian
company I invested in, made their own stent design and launched a production
factory in Western Siberia. Our prices are three to four times lower that
prices for the same class of stents from the US competitors and the quality is
the same or higher. We fought out 15% or the market for the last two years.

I have to say, that almost 99% of all stents in Russia are installed at the
cost of the state medical insurance - every person in Russia is covered by
this insurance, and that insurance is just sponsored by the state or local
budget. The budget allocated to this kind of medical support is fixed, so if
the yearly budget is 100M rubles (our local currency) and cost of a
manipulation and a stent is 100K rubles then you can install stents in 1000
patients in one year. If the price goes down four-fold, then it will be 4000
patients. And this stent manipulation is a life saver in true sense of this
word. So, basically with our stents we can save four times more people's
lives, which on a scale of Russia would be tens of thousands of people.

Here enters the greed and corruption. One of the US companies approached one
of the most powerful Russian oligarchs with good ties in the government. He
lobbied a government decree stating that this US company will be single
supplier for cardiology stents starting Jan, 2017. So, all hospitals and
clinics are obliged to buy stents only from them, at the price they set. Tens
of thousands of Russian people will die each year because of the greed and
corruption - and we can't do much about it.

~~~
rayiner
Greed in the medical industry doesn't "kill people." There is a difference
between not saving someone's life and taking it. That moral distinction
undergirds our whole economy.

Corruption is bad, no doubt. But the double standard applied to medical
companies makes no sense. If _not saving lives_ is the same as _taking ones_ ,
then many of the things developed by Silicon Valley are morally abhorrent. How
many lives could be saved if the billions of dollars flowing into Facebook,
Twitter, Tindr, YouTube, Netflix, etc. were used to buy or develop medicine? I
could save the life of a kid in Africa suffering from malaria, but instead I
chose to purchase a new Apple Watch. If people actually applied your moral
principle in a non-hypocritical way, we'd have almost nothing to talk about on
HN.

~~~
mikeash
There's a difference between not saving someone's life and bribing an official
to stop someone else from saving lives. This is no different than if I got a
law passed saying that nobody was allowed to sell or give food to you. When
you starve to death, would you say you weren't killed?

~~~
rayiner
I agree with you about the specific example. But this thread is about the
EpiPen, where no officials were bribed and where there was an FDA-approved
alternative on the market until it was voluntarily withdrawn. The outrage is
over Mylan taking advantage of transient market conditions to jack up the
price on their product.

~~~
mikeash
The overall thread was about the EpiPen, but you replied to a comment
describing a pretty clear-cut case where bribery was getting people killed,
and you wrote a completely general comment saying that greed in this industry
wasn't killing people.

If you only meant that to apply to the EpiPen, and not to Russians being
killed by their own government because of corruption related to cardiac
stents, you chose a really weird way to go about it.

~~~
rayiner
The comment I replied to led with a general point about greed in the medical
industry getting people killed, and was in a thread about EpiPen. If it wasn't
meant to be a comment on the medical industry generally, not just a specific
case in Russia, that's pretty weird.

~~~
mikeash
Except that "greed in the industry is killing people" is true even if it's
rare. "Greed in the medical industry doesn't 'kill people.'" is false if
there's just one instance to the contrary. So trying to reverse my argument,
while witty, doesn't really work.

------
suprgeek
The Hackers groups are doing what they can to expose Mylan's (EpiPen makers)
Greed which is laudable. What is really needed is also an explainer on why a
bit of govt. leverage (socialism if you will) is good in Medicine Pricing as
well.

Mylan is a really great user of buying legislation. They leveraged their 90%
market ownership of the epinephrine auto-injector market such that

[1] It lobbied hard to ensure that all parents of school going kids (or tax
payers) paid for EpiPens by making it into a bill that politicians could
easily justify.

Once the bill passed and schools all over the country purchased these by the
boatloads, then they just kept raising the price over and over and milking the
profits.

When it got too much and they could not ignore the patient backlash they have
turned again to purchasing legislation..

[2] Now they want to make it so that the patients do not see the copays -
instead every one suffers by paying more for health insurance.

[1]
[https://www.opensecrets.org/lobby/billsum.php?id=hr2094-113](https://www.opensecrets.org/lobby/billsum.php?id=hr2094-113)

[2] [http://www.nytimes.com/2016/09/16/business/epipen-maker-
myla...](http://www.nytimes.com/2016/09/16/business/epipen-maker-mylan-
preventative-drug-campaign.html)

With scumbags like these, is it any wonder that the USA has the most expensive
healthcare system in the world?

~~~
anaolykarpov
Can this be a side effect of the "free healthcare" goal that the state is
trying to achieve?

When people don't have to pay for something straight from their pocket,
they're not feeling the ripoff so strongly, so they don't revolt.

That's why I personally think that the systems where people vote with their
wallets are much more efficient.

~~~
willvarfar
And yet in countries with universal health care, the cost of health care in
real total terms is much lower:
[https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...](https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita)

Monopolies can dictate terms, which is why monopolistic companies are
regulated. But if that monopoly is the state, then it actually works in the
citizens favour if the monopoly presses down costs.

~~~
hueving
So the question that comes up with this, if there is no free market like the
US medical system, would it kill the incentive for biomedical startups and
pharmaceutical research in general (which is largely based on the US now).

~~~
vvvv
Is the R&D largely based in the US?

Also, it's important to distinguish between true R&D aimed at developing
actual cures and iterative R&D aimed at developing medicine that will get you
hooked on long-term courses that maximise profits.

~~~
willvarfar
And R&D aimed at developing replacements for perfectly-fine drugs that are
soon to go out of patent, or R&D that is put on a back burner until some other
drug is about to go out of patent etc.

------
SteveGregory
Probably too late to really contribute, but either way -

I feel like health is a degenerate case of free markets. In any free market,
the price is set by the consumers assessing their utility for the goods or
services purchased. In cases of pencils, productivity software, energy, raw
materials, etc, consumers compare the methods of resolving the need, or at
baseline the cost of not addressing the need.

In healthcare, there are lots of situations where the cost is X dollars vs
literal death. Of course, death is not an acceptable alternative, so an
acceptable X ends up being very, very high for the treatment. Most people
would pay their life savings to treat themselves of any life-threatoning
ailment.

I honestly believe that free markets setting prices is good for most
industries, but I cannot see it working in situations where the benefit
categorically supercedes any amount of money.

It seems like we need to either rethink IP law surrounding healthcare, or have
a monopsony (single payer or something else) setting prices.

This is a hard thing for me to resolve, as somebody who normally likes a
libertarian approach.

~~~
nickff
The choice in a free market is not between one specific product and non-
consumption, it is between that product and all alternatives (including non-
consumption). If the choice was always between one specific product and non-
consumption, bottled water would be very expensive (since water is second only
to oxygen in necessity for survival). If there are no good alternatives, we
should first ask why that is, before confiscating property or rights from that
supplier or provider. I would contend that the healthcare industry has been
poorly (over-) regulated, and that government interventions have limited
supply of critical goods and services, thus increasing prices and decreasing
quality.

~~~
metafunctor
Consumer choice is, indeed, the underpinning of the free market.

What is preventing other companies to come to market with cheaper versions of
the EpiPen? Why are there no cheaper alternatives?

~~~
nickff
I believe there are three alternatives: Epipen, Adrenaclick, and Twinject. The
FDA does not allow pharmacists to substitute one for the other at the
pharmacy, and many (doctors and patients) opt for the best-known brand.

~~~
metafunctor
A-ha! This is new information to me. Why are EpiPen substitutes not allowed?
Are the products that different?

~~~
DashRattlesnake
> Why are EpiPen substitutes not allowed?

My understanding is if the prescription says "EpiPen" (or any non-generic drug
brand name) the pharmacist must provide an EpiPen (or the brand-name drug). If
the prescription says "epinephrine auto injector" or "EpiPen or generic," then
the substitution is allowed.

> Are the products that different?

IIRC, they all the current alternatives deliver the same medicine, but they
use different injector mechanisms to do so. I think the last alternative
withdrew from the US market for some reason, because their mechanism wasn't as
reliable with dosing.

IIRC, EpiPen's mechanism is apparently off-patent, so a true generic could
enter the market if approved.

------
anaolykarpov
The title could be rephrased as "Cheap guys risk the lives of thousands of
people by promising savings of a few bucks".

The problem is not with the "greedy corporations", but with the poorly
dedigned legislation regarding intellectual property rights.

The state created the protectionist environment in which companies can become
bullies and be sure that they won't be exposed to any economic competition.

Of course, the complete lack of IP laws would deter companies from investing
in research, but the same effect have too strong IP laws. Why would a company
risk their money and do research once they found a cash cow which can be
milked for a long time, having the state guarantee it?

~~~
justifier
this comment seems wholly unwarranted

how do you think this effort puts thousands of people at risk?

if you download the instruction packet(o) it comes with a Links.txt file that
has a link to an instructions video.. which at the time of writing this
comment can be found at:
[https://www.youtube.com/watch?v=ldFFJRdhVs8](https://www.youtube.com/watch?v=ldFFJRdhVs8)
; i suggest you watch it

all of the components are 'off the shelf' and the drugs are prescription

from this(i) ~random site epinephrine costs 74.95$ for 30mL, the instructions
call for .3mL, that is 100 uses from this 75$ vial, or 75 cents of epineprhine
per epipencil

when i read the article i thought this was a great effort that could save the
lives of anyone who was unable to bare the new price of the epipen, but now i
am wondering what from the epipen warrants the price tag? can a loved one even
sue epipen if it malfunctions and kills the intended user?

(o)
[https://fourthievesvinegar.org/download/#epipencil](https://fourthievesvinegar.org/download/#epipencil)

(i) [http://www.buyemp.com/product/epinephrine-
vial](http://www.buyemp.com/product/epinephrine-vial)

~~~
amelius
> how do you think this effort puts thousands of people at risk?

IANAMD, but I suppose air bubbles in the injector could cause problems (?)

~~~
probably_wrong
As far as I understand: a regular bubble of air, while undesirable, won't kill
you. That's part of what the lungs are for, and in fact it happens in
hospitals all the time.

A very large bubble can kill you, but you need to put some serious effort [1].

[1] [http://www.straightdope.com/columns/read/2866/can-air-
inject...](http://www.straightdope.com/columns/read/2866/can-air-injected-
into-the-bloodstream-really-kill-you)

------
fernly
TIL that an "autoject" is an inexpensive self-injection tool commonly used by
diabetics[1] that can be carried safely and used easily. It can be loaded with
Insulin, or with any drug whatever. The OP article describes using it to
inject epinephrine, stating that

> A 1mL vial of epinephrine costs about $2.50... Doses range from 0.01mL for
> babies, to 0.1mL for children, to 0.3mL for adults.

In other words, if your doctor will give you a prescription for the drug
itself, you could assemble three epipen equivalents for less than $100.

[1] [https://smile.amazon.com/AJ-1311-Autoject-Injection-
Removabl...](https://smile.amazon.com/AJ-1311-Autoject-Injection-
Removable/dp/B002M3TBUS/)

~~~
ChuckMcM
The trick being that you need a larger needle to inject the epinephrine and
they discuss how you can combine two syringes to get the larger needle.

------
mikekij
(preparing for an onslaught of down votes, but here we go.)

It's awesome to see a 'hacker' building a $30 EpiPen. But looking only at the
materials cost for a medical device ignores the millions (sometimes billions?)
of dollars spent on R&D, IP licensing, and (perhaps most significantly)
regulatory compliance.

The pricing system for devices and drugs is definitely screwed up in the US,
but Mylan's 36% gross margin on the devices doesn't seem criminal.

Perhaps they're padding their cost numbers. And perhaps there are IP
shenanigans at play that I'm not aware of. But one needs a thorough
understanding of the _total_ costs to invent, develop, achieve regulatory
clearance for, and market a medical device in order to assess the morality of
the pricing.

~~~
steamer25
> R&D, IP licensing, and (perhaps most significantly) regulatory compliance

I'm going to call the R&D costs a wash because that cost should also be
factored into the price of the diabetic injector that forms the basis of the
$30 homebrew design.

From your list, that leaves IP licensing and regulatory compliance which are
both imposed by the state.

I believe we would still see plenty of (and actually probably more) innovation
with a much more relaxed IP policy that favored small, incremental
improvements and the diversity of product variations that competition would
bring. In short, copyright terms should be 5-10 years max and should only be
granted in cases where there's proof of significant research. Simply, if the
ability to monopolize your 'idea' for the better part of a decade doesn't
incentivize you sufficiently--it's likewise not worth depriving the public
over it.

With regards to regulatory compliance, I believe we're seeing a case of the
perfect becoming the enemy of the good. Imagine if the state extended the
good-Samaritan policy to all medical providers--legally protecting anyone who
exercises good-faith and due-diligence towards improving the health of their
fellow man. Also, replace the old-west era FDA with information-age search
engines, customer reviews and a plethora of private Consumer Reports -type
organizations. In this scenario, there are several auto-injectors available on
the market ranging from a $30 model which has failure rate of 50% to a $600
model that's been tested out the wazoo and only fails 1% of the time. Even
under this very pessimistic scenario (50% seems pretty conservative to me),
many lives are saved because there's a long tail of people who can't afford
the $600 model but more than half of them end up surviving an episode of
anaphylaxis because they can access the low and mid -range models.

~~~
mikekij
I agree with everything above (except the R&D costs thing). The only issue is
that Mylan is operating in the current regulatory environment, not the one you
described. So at least part of the outrage about the cost should be directed
at the regulatory framework we're working in, as well as the distribution
channels and methods.

I think this is what Mylan's CEO was attempting to convey on Bloomberg,
although with questionable success.

------
sp527
This doesn't feel like the right platform for DIY. When someone needs an
EpiPen, it's because they might be dying. Presumably, a large and well-
capitalized organization will have tested their device extensively and can
offer better guarantees about it actually working (I should stress
_presumably_ ). There are a lot of ways in which the hacker mindset can be
beneficial to society, but this particular application feels like an ethical
gray area.

~~~
bisby
The headline says "to expose corporate greed"

The premise is that $57 was the old price. and they bumped it up to $318.

And a DIY group can pull it off for $30, without economy of scale.

From wikipedia "In 2007 when Mylan acquired the rights to market the product,
annual sales of all epinephrine autoinjectors were about $200M and EpiPen had
around 90% of the market; in 2015 the market size was around $1.5B and Mylan
still had about 90% of the market"... $1.5B annually... So if FDA testing
costs them $10,000,000 anually, thats still less than 1% of their revenue.

That means that with economy of scale, and dispersing the cost of testing over
several million sales, they could easily produce a product for $30. But they
don't because they dont really care about saving lives, they care about
getting paid. They would prefer people die than them make less money.

Completely not about "hey do it this cheap easier way" but "heres the rock
solid proof that a $300 (even $60) EpiPen is stupid"

~~~
mc32
While I agree $300 is a ripoff and takes advantage of how medicine works in
the US (i.e. the cost for most users is opaque b/c insurance pays) I can also
see that $30 is not likely a viable price --just like I can put a sandwich
together for $3 doesn't mean I can run a profitable sandwich shop selling
sandwiches at $3.

As a consumer I could see this for $75 - $100 retail (and some discount to
institutional buyers) but $30 is probably not viable and of course $300 is
ridiculous.

~~~
jellicle
Autoinjectors for other drugs sell at $33 retail:
[http://www.buyemp.com/product/meridian-auto-
injectors](http://www.buyemp.com/product/meridian-auto-injectors)

They (including epipens) probably cost about $10 to make. That's total cost,
from production to delivery to the retail outlet. They would have been
handsomely profitable at the old price of $57.

~~~
mc32
Yeah, that seems like a fair take. They'd get away with a little inflation
--so $75 - $100 but definitely not $300. That's just opportunistic gouging.

------
zaroth
So "Four Thieves Vinegar" says their DIY auto-injector works probably almost
as well as the EpiPen. Sign me up! </s>

Are we really complaining about an "onerous regulatory process" for a device
which untrained laymen need to be able to use in a high stress emergency
situation?

I'd like to see Four Thieves Vinegar fund the necessary trials to prove their
device is safe, gain FDA approval, bring the device to market, and defend
themselves against the inevitable lawsuits, and _then_ tell us how they can
sell the device with less than 80% gross margins. The marginal cost of making
one more pill or one more device is almost entirely irrelevant, and any
article that tries to make a case for a medical product being overpriced based
on COGS isn't worth reading IMO.

The price for EpiPens went up because no one else was able to make a competing
product that didn't malfunction or deliver the wrong dose of epinephrine.

~~~
TheAnimus
> The price for EpiPens went up because no one else was able to make a
> competing product that didn't malfunction or deliver the wrong dose of
> epinephrine.

Price hasn't gone up as much in the UK where a state monopoly negotiates.

~~~
EpicEng
And none of this stuff is being invented in the UK either. US is the king of
drug discovery. I'm not saying that I like the current system, because in many
ways I don't, but let's not ignore the fact that countries like the UK are not
producers.

------
justinlardinois
I feel like a lot of the commenters here didn't read the article.

> Four Thieves Vinegar have created and uploaded the plans for the simple
> version, called the Epipencil. Also spring loaded, the parts are gathered
> over the counter. The epinephrine will still need to be acquired with a
> prescription.

This still involves an FDA-approved drug obtained through normal channels; the
DIY part is the injector.

Creating DIY medical drugs would certainly be something to be concerned about,
but I don't see the problem with DIY medical tools.

~~~
snowwrestler
The problem is that if an auto-injector is truly needed (onset of
anaphylaxis), there may not be much time to futz around with it, if it doesn't
work properly.

The auto-injector apparatus is not regulated because it is dangerous; it is
regulated because a failure to operate would be dangerous. It is regulated for
reliability.

The hacker/maker ethos is awesome and drives a lot of innovation in our
society, but sometimes there is also a need for careful engineering and
rigorous testing.

~~~
BurningFrog
Right, but something 90% effective that you can afford will save a lot more
lives than the 100% effective version you can't.

~~~
abraae
Well put.

I've got a heart issue going on and I've had some fascinating results from
capturing my heart rate on a consumer grade chest band monitor, then uploading
it to influxdb and viewing it with grafana. Total outlay a couple of hundred
bucks. Invaluable to me in tracking what's going on with my heart.

Yet that whole stack would never be approved by... Anyone!

~~~
gravypod
You should open source it. Would be cool to see how you're doing data vis for
this.

------
ncavet
"Hacking" medicine doesn't really work. See Theranos.

First, epenephrine degrades when exposed to light so your epipencil may be
ineffective from the start.

Second, parents when measured took 2.5 minutes to fill a syringe with
epinephrine which is not fast enough in an emergency.

The price gouging is terrible. There are cheaper alternatives but Epi-pen has
the most well known brand.

People buy Tylenol and Advil not Aspirin and Ibruprofen.

Drs have appealed to ban drug advertising. Medicine should have no place in
capitalism.

Source: [http://www.aaaai.org/ask-the-expert/effect-of-light-on-
epine...](http://www.aaaai.org/ask-the-expert/effect-of-light-on-epinephrine)

~~~
jedmeyers
> People buy Tylenol and Advil not Aspirin and Ibruprofen.

Aspirin is still a registered trademark of the acetylsalicylic acid in many
countries and it's owned by Bayer AG. The generic name of Tylenol is
acetaminophen (paracetamol).

~~~
abduhl
Aspirin lost its trademark status in the major Allied nations during WW2 when
their assets were confiscated.

~~~
lantastic
Trademarks were part of the confiscation during WW2, but Aspirin lost its
trademark status in US long before that[1].

[1]
[https://cyber.harvard.edu/metaschool/fisher/domain/tmcases/b...](https://cyber.harvard.edu/metaschool/fisher/domain/tmcases/bayer.htm)

------
agotterer
Michael gave a fantastic talk at Hope this year titled "how to torrent a
pharmaceutical" where he made Daraprim on stage for only a few cents. Its
defingely worth watching:
[http://livestream.com/internetsociety3/hopeconf/videos/13073...](http://livestream.com/internetsociety3/hopeconf/videos/130731041)

~~~
chillacy
Great talk. Chematica looks really cool, as a way to discover new ways to
synthesize chemicals, just by searching a graph of possible reactions in order
to reach the target chemical.

------
CodeWriter23
If you are persistent, you can get CVS to order the "generic" epinephrine
injector for $5.

[https://www.facebook.com/barbara.k.hollinger/posts/128523673...](https://www.facebook.com/barbara.k.hollinger/posts/1285236738177708)

------
enoch_r
The hack here is simple: this group did not get FDA approval for their device.
Greedy corporations have _repeatedly_ tried to make money by competing with
Mylan with cheaper Epipens, but they've been prohibited from doing so by the
US government (not so in Europe, where the unfortunate Europeans suffer
_eight_ greedy corporations trying to drive prices down).

[http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-
dr...](http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs-
chairs/)

~~~
maxerickson
There is Adrenaclick. And 2 generics for it.

(So all you have to do is convince your doctor to write Adrenaclick on your
prescription and you can buy the generic for $145 at Walmart)

That price is interesting because it puts some kind of cap on the amount that
regulation is leading to the price increase for Epipens. The regulation about
substituting Adrenaclick on a prescription for Epipen can be argued, but any
doctor that won't write Adrenaclick after a minute of discussion better have a
good reason.

------
contingencies
I just checked and here in China you can buy 10x1mg doses of epinephrine
(which is actually adrenalin) over the counter/online for 4元 ($0.6USD) ...
[https://world.taobao.com/search/search.htm?sort=price&_ksTS=...](https://world.taobao.com/search/search.htm?sort=price&_ksTS=1474517174609_40&search_type=0&json=on&module=sortList&_input_charset=utf-8&s=0&navigator=all&q=肾上腺素)

That means the epinephrine (adrenalin) itself is essentially free. What do
they charge in the US/Europe/Australia?

~~~
a3n
Yes, it's the patented injector with precise and reliable dosing that is the
cost. Mis-dosing can kill.

~~~
contingencies
I seriously doubt they would be handing out 1mg doses like candy if it was as
dangerous as you suggest. China has actually been quite strong with
controlling potentially fatal drug distribution in the last 15 years,
tightening rules for many substances. The key reason is suicide prevention.
Wikipedia says "Although it is commonly believed that administration of
adrenaline may cause heart failure by constricting coronary arteries, this is
not the case"
[https://en.wikipedia.org/wiki/Epinephrine#Adverse_effects](https://en.wikipedia.org/wiki/Epinephrine#Adverse_effects)

(Edit reply to a3n below: My point was that it's not as dangerous as you are
making out, not emotional appeals and cultural norms for responsible
parenting. Self-administration: good enough for 3 billion+ in
China/India/other developing world locations, good enough for me. The whole
idea of stabbing yourself with a fat dose of adrenaline is pretty hackish
anyway and shows how undeveloped our medical knowledge still is.)

~~~
a3n
If you're injecting with a traditional syringe, you can see how much you're
drawing into the syringe, and presumably can create an accurate dose. Assuming
you aren't untrained and panicking.

The idea behind the auto injectors is accuracy with relatively little training
and skill; a parent can do it while they're watching their kid strangle.
That's why you buy an auto injector instead of syringes.

Competing auto injectors have not been as accurate and simple to use, is what
I've read.

I would not trust my kid's life to a hacker injector; these are medical
devices that are required to go through trials. Even traditional syringes are
regulated. Sure, maybe you can decide to use an unregulated injector; I
wouldn't, not for my kid.

~~~
chillacy
> Competing auto injectors have not been as accurate and simple to use, is
> what I've read.

Also legally EpiPen must be fulfilled by a brandname version instead of
alternatives, and alternatives are scarce due to the difficulty of passing
regulatory approval: [http://slatestarcodex.com/2016/08/29/reverse-
voxsplaining-dr...](http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-
drugs-vs-chairs/)

------
bayesian_horse
It may be better than having no epinephrine at hand. But other than that,
there are a lot of problems: How sure are you that it will work when you need
it? Can you fill the syringe cleanly enough? Will the epinephrine in the
syringe degrade, or worse, develop a bacterial growth?

It may be a better Idea to look into a syringe+vial combination on hand,
prescribed by a doctor. Less convenient, and you need to learn how to use it
(and preferably teach those close to you), but this may be a whole lot safer.
The downside of course is the problem of self-administration when in
anaphylactic shock.

------
snow_mac
I've had to use an EpiPen twice in my life. Oh my gosh, the terror in your
heart when you're self administering it is real. I will never forget the
experience for the rest of my life. I don't want to trust some hack with no
FDA approval in that moment.

I don't give a damn if the product is $50 or $500. I will buy it, it's saved
my life many times. Its not awesome to see a hacker point out while the
materials are cheap

~~~
JoeAltmaier
Imagine the terror if you can't afford one, and you need one. The hack
wouldn't be so unwelcome then?

~~~
snow_mac
If you had an issue where you needed one, nothing would stop you from getting
one no matter the cost

~~~
pwinnski
If it's a case of cutting back on the coffee budget to ensure one always has
an epipen handy, of course you're right.

If it's a case of having to choose between paying the paying the electricity
bill and buying an epipen, and you have to guess at the probability of you
needing an epipen in the next month vs the certainty of the electric company
shutting off your power, with the extra fees and penalties that'll cost to
turn it back on, "no matter the cost" is no longer the standard to use.

------
jpalomaki
Wouldn't it be better to focus on the reasons why there is no viable
competition for this company even though the business seems to be extremely
profitable?

The article links to another that lists some of the issues:
[https://www.statnews.com/2016/09/09/epipen-lack-of-
innovatio...](https://www.statnews.com/2016/09/09/epipen-lack-of-innovation/)

This points out (among other things) that the design is patent protected and
FDA rules make it difficult to come up with other designs that don't violate
the patent. It is also mentioned that the devices need to go through long and
expensive regulatory process.

------
chillacy
Regarding the original price hike which motivated this project, I saw an
interesting perspective on the matter:
[https://www.youtube.com/watch?v=RoMlxVimwiU](https://www.youtube.com/watch?v=RoMlxVimwiU)

Now granted Shkreli is a controversial figure, but basically drug companies
are businesses, and if you sort of detach yourself and look from a business
perspective and value-based pricing, Epipen competes with the ER, and $600 is
a bargain vs an ER visit.

And of course his ultimate conclusion is that maybe life saving drugs are more
like water and power than cell phones and wine? Maybe the government should
get involved in making generic drugs available.

~~~
r00fus
> if you sort of detach yourself and look from a business perspective and
> value-based pricing, Epipen competes with the ER, and $600 is a bargain vs
> an ER visit.

This is exploitation of inelastic demand (death is a pretty high priced
alternative to $600), and it's pretty clear that's exactly what government
regulations and market controls are supposed to protect against.

~~~
chillacy
Yes, that is the conclusion that he reached: that the government should just
nationalize generics for public benefit. That's sort of the extreme version of
mandated pricing.

Someone else in the comment section shared another perspective which reaches
the opposite conclusion: that these regulations have created the problems in
the first place, and the government should not touch this sector at all:
[http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-
dr...](http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs-
chairs/)

------
jMyles
Somewhat tangential: I surmise that this title will be subject to editing by
HN staff, but I think that "Hacker group creates $30 DIY Epipen to expose
corporate greed and save lives" is an exemplary post title for HN and want to
see more like it.

~~~
jMyles
Sure enough, the title was changed to "It Costs $30 to Make a DIY EpiPen,"
which strips out several important details: Who did it, why they did it, and
what they hope the results will be.

------
a-no-n
Just saw more Epipen Congressional testimony. The actual unit cost of the
Epipen (whether branded or "generic") is around $67 USD. Assuming that this
cost were not overly inflated beyond actual overhead and unit costs, in order
to be sustainable, a reasonable retail price without distributors would be
$134 USD... with distributors $200-238.

That said, the more downward pressure from competitors (commercial or
nonprofit projects), the better for customers; especially where a monopoly
existed, it's rational to for customers to band together and attack excessive
hegemony.

Enteprising folks need to jump on this to sell this as a kit (w/ or w/o the
medication).

~~~
chillacy
> Enteprising folks need to jump on this to sell this as a kit (w/ or w/o the
> medication).

Unfortunately, that's a real great way to get shut down by the FDA. Medical
devices are after all subject to regulation. Others have tried making their
own epipens too, but they all keep running into the slow approval process and
unfavorable laws protecting Epipen: [http://www.washingtonexaminer.com/fda-
partly-to-blame-in-epi...](http://www.washingtonexaminer.com/fda-partly-to-
blame-in-epipen-price-debacle/article/2600315)

Also as we know from value based pricing, things aren't priced based on unit
costs (otherwise all software should be essentially free, and the software
industry is the greediest industry on earth), but rather what customers will
pay. And when there are no alternatives, you get to set the price.

------
iamflimflam1
"3.1.24 The health economics model assumes that people who receive adrenaline
auto-injectors will be allocated two epinephrine pens (EpiPens) with an
average shelf-life of 6 months. Each auto-inject EpiPen costs the NHS £28.77
(British national formulary 60). This equates to £115.08 per person per year."

[https://www.nice.org.uk/guidance/cg116/resources/costing-
rep...](https://www.nice.org.uk/guidance/cg116/resources/costing-
report-136427293)

From 2011 - but I can't imagine the cost has gone up by that much.

------
smsm42
$30 is way too much, production cost of EpiPen is probably in single-digit
dollars, maybe even less. That's not the point, nobody thinks EpiPen costs
$300 to produce.

The system it built in a very specific and deliberate way in the US - there
are patented drugs that are expensive, by design, and the pharma is supposed
to finance R&D and FDA testing and so on from that money, instead of financing
it through taxation, or venture investing, or other means. Now, one can claim
maybe Mylan is abusing the system and the money that were supposed to finance
R&D are instead financing lavish salaries or whatever. And one can claim the
system should not be built at all like this but should be built other way.
Maybe.

But completely ignoring the whole design and saying "ah, we've discovered it
costs $30!" is useless. Yes, it actually costs even less to manufacture, way
less. It's obvious. The reason why Mylan charges more is not because it costs
a lot to manufacture. The reason is because that's how patented drugs market
in US works. If one wants to change it, it needs to be understood how it
works. It's not corruption, it's the design of the system.

------
wodenokoto
There are 3 epipens in this article.

The non-generic at ~$350

The generic at ~$150

And the homemade at ~$30

The homemade is equivalent to the generic and the difference between generic
and non-generic is not clearly mentioned so let's talk about the price of the
generic epipen.

According to the article there is difficult bureaucracy to navigate and very
large liability should an epipen fail. On top of that there's distribution and
offices that needs a cut or to be paid for.

Is 5x markup that horrible?

------
robomartin
Ther's an abysmal difference between hacking something together an
manufacturing a reliable product at scale that people can bet their lives on.
Everything, from R&D to the cost of lawsuits, FDA trials and regulatory
frameworks makes these comparisons dumb and ridiculous.

I've been manufacturing products for thirty years. It's never simple for good
products, not even a cup of coffee at Starbucks.

------
eggy
I am a hacker at heart, and I believe there are definitely some shady dealings
with government and industry lobbyists, however, I like to look at things on
both sides, since there is always another side.

Truth is if it was more than one hacker in this collective making the
'Epipencil' they must have designed, procured materials, fabricated and did
this all in less than an hour to say $30, and they would have had to do all of
that in less than an hour to meet minimum wage requirements.

This does NOT speak to QA/QC, testing, insurance, FDA approval, legal costs or
even their hacker lab overhead in equipment and energy to make one, let alone
hundreds of thousands of these potentially life-saving products.

My guess is that the $150 per Epipen is close to what you need to fulfill all
of the above and then some requirements. Far from the $300 or more in pen
price hikes, so it was good they did this as an exercise for putting Mylan and
government in the spotlight. Bravo, really!

My belief is that it is not solely big bad corporations, but big bad
government AND big bad corporations. Just look at the moral integrity of our
two current POTUS candidates.

I am trying to become more financially literate in my old age, and I am trying
to teach my children likewise, since financial illiteracy is a deterrent to
poor people improving their lives, or hackers making a worthwhile dollar in
conjunction with learning and exploration.

I tell my kids to think twice when they reactively say or answer:

"ASAP" \- when is that? Point to a date on the calendar;

"It will take 5 min." \- It never takes just a minute or five;

"It only cost $8 for the materials." \- How much is your time worth? Learning
is a benefit that cannot be quantified too easily, but for other matters, you
need to value your time.

~~~
ZenoArrow
You're getting too tied up into the specifics. I don't think you need to
believe that the price of an Epipen should be $30 to see the point about price
gouging.

If you really wanted a better estimate of costs, you should look at costs
around wages, etc... as you indicate, as well as the cost reduction that comes
from improved manufacturing processes.

The central issue though is not about the specific price, it's about looking
at the point when profit evolves into price gouging. It's not something that
can be quantified precisely, but it's fairly clear that we're far from an
'optimised' price for this product, and we'll probably only get to that price
with effective competition.

~~~
eggy
No, I actually agreed with the gist of the article. And I do think the group
has brought a greedy company to task.

I was speaking to financial illiteracy, and perhaps I didn't communicate it
too well.

I know costing well, and I even had a truly innovative, potential Medicaid
device to aid blind people in walking unassisted by canes, or canines way back
in 1995.

I am not sure how cheap an Epipen can be made at a sufficient profit for a
company to either take it on as their only product, or as a horizontal or
vertical market offshoot of their existing business without looking at the
numbers. I strongly suspect it is far from $30 if it is to be made and sold at
sufficient profit and not charity work, or a device of the Theranos/Elizabeth
Holmes kind.

I was pointing at the over-simplified, short title as possibly another
misleading example of what things truly cost to make to have a final price at
$60 or $150 when there is more involved than cost of materials whether bought
in quantity for a prototype or discounted in bulk.

Did any of the lines at the bottom of my post ring with you? I only ask, since
I am an experienced senior manager with a very eclectic skill set, and I have
heard them from the young to the old and experienced, and I am still amazed
when I hear them.

~~~
ZenoArrow
Ah, fair enough, my misunderstanding. As for your points about people
misunderstanding costs, I've no doubt it happens sometimes.

------
throw2016
The expected market response should have been a flood of alternatives at 1/100
or even 1/10 the price since the base ingredient costs pennies. But these
'ideal' market scenarios that are in public interest rarely come through.

What we often get instead are completely self serving and crafty efforts in
collusion with 'ngos' and lobbyists to leech tax payer subsidies and 'force'
it onto institutions via legislation.

This pattern is repeated so often and widely its predictable. Also predictable
is framing it as a capitalism vs socialism issue to trigger and distract while
the corruption continues unabated.

The problem is healthcare is critical. If your checks and balances and
idealised system does not work you risk letting people feed on others
desperation and create demons. And these sociopaths then multiply within your
society killing it from within. This is the biggest argument for socialized
healthcare.

------
wyager
> corporate greed

Can we please give blame where it's due?
[http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-
dr...](http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs-
chairs/)

~~~
maxerickson
Generic Adrenaclick is $145. Maybe some of the rest of the $455 difference can
be explained by regulation, but a lot of it comes down to Mylan choosing to
price the drug that way.

You can also look at Mylan offering $300 coupons to consumers to get them to
utilize their insurance. Maybe they are just incredibly generous, but it's
more likely that they are happy to net the $300 from the insurance (in other
words, they profit at $300).

~~~
wyager
> a lot of it comes down to Mylan choosing to price the drug that way.

Because the FDA is killing off any competitors. Did you read the link?

~~~
maxerickson
I mention a competitor in the first sentence of my comment!

Feel free to complain about the substitution rules surrounding Epipen
prescriptions, but it's clearly a competitor in the sense you invoke with
_killing off any competitors_. It's the same dose of the same drug intended
for use in the same situations.

------
pingec
The original costs about 33€ in Slovenia
[http://www.cbz.si/cbz/bazazdr2.nsf/o/208079B7D727DABEC1257C7...](http://www.cbz.si/cbz/bazazdr2.nsf/o/208079B7D727DABEC1257C780004AFA0?opendocument)

------
amalcon
This is an interesting approach. I've been wondering about refilling the
things -- once the injectors I have expire, I may disassemble one to see if I
can work that out.

As long as the needle hasn't been used, and the refill is the same dosage as
it came with, I'd expect it to be just as effective as a new injector.

(Disclaimer: I am not a doctor, even if I were you're not paying me, this is
not medical advice)

This may be legal to do commercially as well, since you're not manufacturing
new devices that could infringe the patent. Sorting out FDA issues would be
the only hard part (though likely very hard).

(Disclaimer: Nor am I a lawyer, and you are still not paying me, this is not
legal advice)

------
heironimus
There are so many reasons the EpiPen costs $318, corporate greed being one of
them. One of the huge reasons that no one talks about is that most rarely
actually sell for $318. It's priced at that, but insurance companies negotiate
a lower (unpublished) price in most/all insurance purchases. It's only those
with no insurance or who are buying it without insurance that pay the full
price.

This is true for nearly all drugs, medical equipment, or medical procedures in
the US. This is one of the huge problems with our system. Everyone puts a huge
price-tag on their stuff knowing that insurance with negotiate down.

To me, this seems like the biggest problem here.

~~~
atonse
Yes but I spoke to a parent who said that in many cases and situations, they
are required to purchase more than what insurance covers.

Nobody cares about what insurance companies pay. Like you said, they have
professional negotiators on their side. But cash patients, people without
insurance, or people required to buy more than what their insurance covers, do
need the help.

~~~
hnal943
I recently had a hospital bill where they forgot to bill my insurance. They
automatically gave me a 40% discount, before I even asked them. That's not to
say that the price doesn't matter, but that no one should actually pay MSRP
for medical care regardless of insurance.

------
bonoboTP
Is EpiPen that well known among Americans? I (non-American) never heard of it
until all the news about it's price in the US.

Does it get prescribed more often in the US than other countries? Why didn't I
know about the existence of this thing?

~~~
AstralStorm
Probably because you don't suffer from life threatening allergies.

In EU we have more than a single brand of epinephrine autoinjectors in the
wild.

~~~
bonoboTP
Probably. But it still seems like many people discuss it as if it was such a
"normal and everyday" thing. There are many kinds of medicine that is taken by
~1% of the population, how could people know about all of them?

Or perhaps it also only got famous in the US due to this price rise.

~~~
AstralStorm
No, they are ubiquitous as the epinephrine autoinjector is a required part of
an extended medical aid kit.

~~~
bonoboTP
Okay, and do ordinary people have/see extended medical aid kits? What is that
by the way? A first-aid kit? Is it in cars, at home, at workplaces or where?

~~~
AstralStorm
At workplaces sometimes, all doctor offices in schools, most GP offices, all
hospitals.

(in EU)

------
a3n
Other big grownup companies have tried to make a precise injector, and not
done nearly as well as Epipen. It's not just a needle in front of a spring. (I
haven't read the article, it won't load atm.)

------
KaiserPro
it does cost $30 to make an epipen.

However.

It needs to be proved to work, which is rightly arduous. Unlike in
(most)software, you can just fix it later. Defects kill. There needs to be a
high bar of evidence to prove that:

A) the drug works

B) It doesn't cause your face to melt off

C) its reliable.

All of this is costly, Now, you have two choices, nationalise your drug R&D
and charge a uniform cost spread over all drug classes, or through general
taxation. Or Sweep away all your regulations on drug prices and start again.
(like why the fuck is medicaid not allowed to collectively bargain on price?
that's taxpayer subsidy right there...)

In the UK there is a thing called NICE, which is semi autonomous and run by
people who can understand stats (ie not politicians) its job is to evaluate
the cost of drugs, and crucially the effectiveness of all drugs prescribed
within the NHS.

Is the drug actually effective? (sure 50% more powerful, but it costs 190%,
just double up the old one, etc etc)

does it provide value for money?

is it safe?

are all the questions they ask. If a drug fails the tests its either written
out of guidelines, or more unusually its banned.

------
ChuckMcM
Pretty neat. I wondered why you could just use an autoinjector like diabetics
use (answer you need a larger diameter needle). Still easily doable and its
all off the shelf made by medical device manufacturers and drug makers so not
so much "DIY" as "repurposing existing medical gear to be more versatile".

------
KKKKkkkk1
How much does it cost to get and maintain FDA approval for marketing the
EpiPen? What are the financial costs of the legal risks you are taking by
selling it to patients? In other words, if it's so lucrative, why isn't anyone
else doing it?

------
repiret
Thats like saying pirated software exposes the greed of software companies. I
don't think that anybody believes that EpiPens themselves are very expensive
at all - just like software, the cost comes from the cost of development,
which in this market consists mostly of regulatory compliance and approval. If
it were easy to bring an epinephrin injector to market, Teva would have
already done so and Sanofi wouldn't have had to recall theirs. If there were
more auto injectors on the market, the prices would go down.

The outrageous price of EpiPens is not a result of corporate greed so much as
a failure of the FDA and Congress - but mostly Congress, the FDA is their
subordinate. They failed to promogulate rules that maintained a competitive
market for epinephrin auto injectors.

~~~
justinlardinois
If the current price of the EpiPen isn't due to corporate greed, then why did
the price used to be significantly lower?

~~~
a3n
It's what the traffic will bear.

The cost is in the patented injector, the drug itself is cheap. Others have
tried to market similar injectors, which didn't work as well as the Epipen.

As cost slowly rose, insurance paid for it, and parents didn't notice it as it
was hidden in rising insurance premiums. Then deductibles skyrocketed, and
suddenly insurance wasn't covering it all; parents had to pay the balance, or
all of it.

If you didn't have insurance, you already watched it go up as it happened.

Finally the cost was raised arbitrarily, to cover the company's coming losses
as their patent on the delivery system will expire. This, I've read recently,
is common: a spike in price before generics take over.

The traffic bears this price, because parents don't want their kids to die
from accidental exposure to peanuts and other allergens.

~~~
lostlogin
I'm missing something - why were the costs rising?

~~~
a3n
Because they could.

------
JustSomeNobody
Ok so Mylan can get them made for $30 and sells them (now) for $150. Is a 5X
sale price not acceptable? If not why aren't people going after every single
product manufactured and sold?

Don't get me wrong, I'm not defending anyone here; that whole industry needs
some fixing. I'm just tossing out the question.

~~~
ralfd
They _announced_ a cheaper $300 product for 2 packs. But my understanding is
that product is not on the market yet. I also wonder if some conditions are
attached to it, as they keep on selling the normal $600 2-pack Epipen.

------
bahmboo
Should be wearing gloves and preserving sterile field for making something
injectable.

------
dang
Url changed from
[https://www.minds.com/blog/view/625077755582623755](https://www.minds.com/blog/view/625077755582623755),
which points to this.

------
tn13
It costs $30 to make an EpiPen at home why dont you create a company and sell
it for $50 and solve the problem all ya complaining about ?

Mylan deserves our appreciation for inventing EpiPen when none of the other
smarty pants who claim to make it in $30 bothered to help the needy.

~~~
smsm42
> why dont you create a company and sell it for $50

Patents. FDA.

> Mylan deserves our appreciation for inventing EpiPen

Mylan didn't invent EpiPen. A guy named Sheldon Kaplan[1] working for company
named Survival Technology did. He didn't get any special money from it. After
a long chain of acquisions the rights to EpiPen ended up in Mylan. They have
nothing to do with its invention except that they paid money to buy rights to
it.

[1]
[https://en.wikipedia.org/wiki/Epinephrine_autoinjector](https://en.wikipedia.org/wiki/Epinephrine_autoinjector)

~~~
tn13
> They have nothing to do with its invention except that they paid money to
> buy rights to it.

That is like saying Google had not hand in success of Youtube because it was
initially done by someone else. Dont you agree that Mylan deserves a hifi for
making it useful and famous ?

~~~
smsm42
Nope. They didn't make it useful (they didn't make it anything, they bought it
as is) and as for famous, the only thing they made it famous for is as an
example of runaway medical costs, which is hardly praise-worthy.

Don't get me wrong, I don't object to the concept of private property,
investment and profit. But I also don't feel particularly obligated to be
thankful for something Mylan didn't actually do.

------
endgame
DON'T POP A NEWSLETTER FORM OVER THE TEXT I AM TRYING TO READ.

I'm sure this is an interesting article but the only way we will stop this
practice is if we stop giving user-hostile publications our eyeballs.

------
pweissbrod
Watch the video. All described is loading epinephrine into an autoinjector.
This is great because it suggests the barrier to competition is relatively low
hanging fruit for those already in the drug delivery markets.

Also: screw mylan

------
Mao_Zedang
If the product is so expensive, and someone can make a competing product for
less viably I find it hard to believe that it hasn't been done. A more fair
comparison would be "medical aid which wasnt subjected to the same regulations
and testing is cheaper to make and distribute" aka Corporate greed.

~~~
chillacy
Not sure how that's greed as much as a case of too much regulation.

Companies exist to make a profit, why are we getting upset when they do so
within the confines of law? Here, the law allows for lobbying and high
regulatory burden which creates a monopoly for EpiPen.

I don't expect public shaming to reduce corporations from seeking profit. I do
have great hopes for reforming laws to incentivize competition so that the
desire for profit benefits us all.

------
crazy1van
If someone knows how to make a product for $30 that the competition charges
$300 for, why not go into business and undercut their price by a huge margin?
Millions of users' lives would be instantly improved with dramatically cheaper
epipens. That will do far more to combat greed than a blog post.

However, I think that if someone were to try this, they'd find there are many
more costs involved than the raw ingredients and it might not be quite so
simple to massively undercut the competition. But still, they should go for
it! Competition is is the best medicine for over priced goods.

~~~
smsm42
> why not go into business and undercut their price by a huge margin

Patents. FDA.

~~~
AstralStorm
FDA mostly. There are other, better ways to deliver epinephrine than with a
spring loaded syringe, e.g. pneumatic injector.

