Mylan is trying to influence the government to make insurers fully cover its pricey EpiPen, a move that could ensure more people get the allergy shot but lead to higher costs elsewhere, a team of doctors say.
The Affordable Care Act requires insurers to cover preventive services without any co-pay, if those services get a top recommendation from the U.S. Preventive Services Task Force. The goal is to ensure that preventive services are covered, but a group of experts said the requirement is having the side effect of companies pushing the federal government to recommend unnecessary products.
Mylan is pushing the task force to deem the allergy drug a preventive medicine so that insurers must cover the entire cost, with no patient co-pay, called “first dollar coverage.” The price for a two-pack of the drug is now about $600.
“This is a blatant attempt to twist the notion of prevention to get first-dollar coverage, specifically to deflect legitimate concerns about the dramatic and as of now indefensible increase in the cost of the device,” according to an article written by several doctors with the American Board of Pediatrics published Tuesday in the journal Annals of Internal Medicine.
The authors say that recommending the EpiPen for the coverage could ensure higher co-pays and deductibles from insurers for non-preventive services as insurers look to pass on the costs to consumers in other ways. That is especially important as the authors say that the EpiPen is not a preventive medicine, but instead is used to treat a life-threatening event of anaphylactic shock.
However, supporters of the move say Mylan is trying to ensure that patients get the EpiPen, which can be difficult because of the steep price, which the company has raised about 400 percent in the last decade to $600 for a two-pack.
Prevention is defined in three ways: preventing a disease before it occurs, detecting and treating a disease before symptoms occur, and using a treatment after a disease develops that is targeted at preventing future complications rather than relieving current symptoms, the article said.
“Mylan is attempting to make a case that when used for the acute treatment (not prevention) of one specific and very symptomatic condition, a medication should be relabeled as a preventive medication,” according to the article.
The doctors point to what Mylan is doing to influence the task force.
“To legitimize this goal, the company has written an article, found a willing physician to attach his name to it, and published it in a medical journal,” the article said. The doctors add that the physician listed as the author didn’t write it, a paid consultant did instead.
That article appeared in the Journal of the American Medical Association in August. It said that due to the increase in high-deductible healthcare plans, a high proportion of patients aren’t carrying around the recommended two auto-injectors at all times. To fix that, the task force needs to deem the EpiPen a preventive medicine, it said.
Mylan did not return a request for comment on the criticism.
The task force is made up of 16 national experts on preventive and evidence-based medicine and has strict controls against conflicts of interest.
The panel doesn’t take into account costs or coverage when making recommendations, only the scientific assessment, the doctors writing Tuesday’s article said.
By linking insurance coverage to the task force’s recommendations, it “encourages those with a significant financial interest to attempt to influence the direction and decision of the Task Force.”
Mylan has made several moves to try to quell the public anger over the EpiPen price, which the company has raised 400 percent since the company acquired it in 2007.
It plans to release a generic of the EpiPen that will sell for $300, and it offered a $300 discount card for the brand name version. Mylan also reached a $465 million settlement with the federal government to put to rest allegations that it misclassified the EpiPen with the federal government so it could pay a lower rebate to Medicaid.
