
Mylan’s EpiPen price hike was a scheme to stifle competition, rival claims - CoolGuySteve
https://arstechnica.com/science/2017/04/lawsuit-mylans-epic-epipen-price-hike-wasnt-about-greed-its-worse/
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matt_morgan
I take issue with the title. Screwing some other corporate conglomerate is not
worse than screwing people at risk of their lives.

~~~
JoeAltmaier
Same result here? By raising prices then offering deep discounts, Mylan
prevented the cheaper alternative from being offered to millions of people.

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phkahler
I always advocate that medical service providers and pharma should be required
to charge the same price to all customers for a given service. Different
providers/doctors would be free to charge different prices of course.
Discounts, rebates, and any other special pricing should not be allowed. The
only possible exception would be a charging LESS for someone (an individual)
who is not insured or has some other financial hardship.

~~~
epmaybe
A more elegant solution in my mind, barring price fixing, would just be price
transparency. Let people see the costs and use their own judgement to pick
what they value more.

~~~
phkahler
That's exactly what I'm talking about. Transparency just adds the idea of
publishing the price up front.

I tried to clarify - different doctors are free to charge different rates for
a given service (say 15K for an appendectomy), to make them charge the same is
price fixing and should not be allowed. What I advocate is that Alice, Bob,
and Charlie all get charged the same price by Dr. Sam regardless of insurance
coverage or any of the other deals that take place today. Dr Alfred is free to
charge a completely different price than Dr Sam.

~~~
epmaybe
Sorry, but I'm not sure I understand. I was under the impression that
different doctors could already charge different rates for the same
procedures. Insurance companies could just refuse to reimburse after a certain
percentage, though.

~~~
phkahler
The problem is that a given provider (doctor or hospital) charges different
rate to patients for the same service (procedure). Now lets not confuse what
the patient pays with what the provider receives because insurance can be
involved. the thing is the insurance companies "negotiate" lower rates in
addition to paying their portion of the bill.

Say two people get their appendix out and the hospital bill is about 15K. One
person is uninsured, so they get a bill for the full amount. The other is
insured, so their insurance company gets a bill for 15K. The insurance company
has an existing agreement with the hospital and says "We're only going to pay
12K" and that's what the hospital gets. Then they pass on the 30 percent of
12K to the patient and get that. This is seen as a bonus the insurance
companies provide - negotiating better prices - 12K vs 15K. But what's really
happening is the hospital is going to try to get 3K more from the uninsured
guy.

My argument (how I think it should be) is that the hospital has to demand the
same payment from everyone for that procedure - you will be responsible for
whatever portion your insurance company doesn't pay, which is full price for
the uninsured. Now the other hospital across town is free to offer the same
procedure for 13K or 8K or 25K - whatever they think they can get, but they
have to charge that price to all patients. This promotes competition between
providers AND insurance companies and it will result in lower prices for both.

~~~
epmaybe
So how granular can the price be? Say you need stents for your coronary artery
disease. Do you price at the number of stents? The number of catheters used?
Just a flat rate for a procedure, regardless of the complexity?

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yaakov34
So Mylan is more evil than Satan's pet vulture for hiking the price of EpiPen
to $600, and the good guys just released a new version of their device for
$4500? Or am I reading TFA wrong?

~~~
quantumhobbit
Yeah I don't understand the $4500 price. Is that per dose? Or is it some sort
of reusable device? Either way it is hard to see that being a viable
competitor.

~~~
epmaybe
It's for 2 pens I believe, last time I checked on their website. The company
is trying to get insurance to cover the costs, so cost for you wouldn't
technically change, but it just increases healthcare costs all around for no
reason other than profit.

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Animats
EpiPen price in the UK: £89.99 [1], or US$115.

[1]
[https://onlinedoctor.lloydspharmacy.com/uk/allergy/epipen](https://onlinedoctor.lloydspharmacy.com/uk/allergy/epipen)

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nomercy400
So what are the chances that a US federal court is going to rule against a US
company with a near 100% marketshare versus a French company that no longer
sells the product?

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matt4077
Please don't spread the idea that courts practice economic nationalism, at
least not without some proof.

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jessaustin
There's a sucker born every minute...

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Super_Jambo
Ah yes "free markets".

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scaryspooky
Except there is very little "free market" about the medical device industry,
which is heavily regulated and also able to abuse the patent system.

~~~
cmdrfred
Probably the most regulated market we have.

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Symmetry
Drugs combine the intensive quality regulations that medical devices have with
_production quotas_ so those probably edge out medical devices.

~~~
cmdrfred
Isn't this a medical device that contains a drug?

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pthreads
tl;dr Sanofi filed a lawsuit against Mylan alleges antitrust behavior.
Essentially the article says that Mylan jacked up prices but offered steep
rebates to "third party payors" on condition that they do not reimburse Auvi-Q
(made by Sanofi) effectively shutting them out of the market.

To me though the kicker was at the very end -- "The list price of the newly
released Auvi-Q is set at $4,500." That is for the device now being sold by
another company (Kaleo). I just don't understand what is going on here. EpiPen
is priced at what $600? CVS sells a generic for about $100 (Adrenaclick).

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taneq
This 'Auvi-Q' thing... I don't get it. It's just a rectangular EpiPen.

Oh wait, it talks to you. Why do you need an EpiPen to talk to you? You
literally just take the cap off, whack it to your (or their) thigh, and count
to 5.

~~~
cowsandmilk
> You literally just take the cap off, whack it to your (or their) thigh, and
> count to 5.

In at least one study[1], admittedly funded by Sanofi, ~1/3 of people stuck
the wrong end into their thing and ~1/2 didn't keep it in long enough. Just to
emphasize on the second item, you said "count to 5" when the EpiPen
instructions say 10 seconds. Only 35% of people completed all the steps
correctly.

[1] [http://www.jaci-
inpractice.org/article/S2213-2198(13)00125-6...](http://www.jaci-
inpractice.org/article/S2213-2198\(13\)00125-6/fulltext)

~~~
pm215
> ~1/3 of people stuck the wrong end into their thing

Ow...

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rm_-rf_slash
Another day, another clear example of the "free" market ossifying into
monopoly absent effective government regulation, while common people suffer.

I yearn for the day that humanity reaches Star Trek ideals, and looks back on
people like the Milan CEO the way we regard magnanimous tyrants and
bloodthirsty war criminals.

~~~
golergka
The current state of EpiPen is a direct result of free will of the original
inventor and the company he worked for when he developed it. The company which
is currently an "evil monopolist" acquired the rights to it as result of free-
market, mutually beneficial transactions. Yes, they offer the tech for a lot
of money - but you are _free_ not to purchase it and use older medicine
instead.

The problem with your type of logic is illustrated best not by the complicated
reality, but (as usual with philosophical problems) a corner case. Imagine
that I invent a fantastic new medicine - and being an evil genius, leave it in
my lab, never announcing it to the world, knowing perfectly well that millions
of people around the world could be saved if I did.

In your logic, this absence of action makes me evil - although these poor
sufferers would suffer just the same if I didn't invent this new medicine to
begin with. The same is true for EpiPen: it's their inaction you condemn, not
action.

The medical industry is not making the world a worse place through it's
actions; it just isn't doing it a better place to an extent that you would
want them to.

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maxerickson
Mylan bought it after someone came up with a minor improvement to the needle
cap and it could be marketed under a patent.

The ridiculous price has little to do with the original inventor.

A not stupid regulatory system would evaluate the value of the improvement to
the market (likely hugely negative in this case). The idea wouldn't be to deny
the company the right to the patent, it would be to deny regulatory approval
for the patented version of the device.

(the argument being that decreased access to the patented device costs more
than the benefit provided by the minor safety improvements it offers).

~~~
golergka
When you got a regulatory system that evaluates value, you got a complex,
corruption and bug prone system.

I'd take my systems stupid and simple, please.

~~~
maxerickson
A simple implementation would force them to market the new pen under a
different name.

They would of course argue that this confuses the marketplace. But they are
sitting there exploiting the confused marketplace, so not much of an argument
to be made along those lines.

