Two of the most contentious health care topics these days are the possible rising costs for patients with pre-existing conditions under the American Health Care Act and the high cost of prescription drugs in general. For families that deal with serious allergies, EpiPens are a perfect storm of both issues. So now that Republicans want to repeal the Affordable Care Act (or "Obamacare"), how much will EpiPens cost under Trumpcare? Unfortunately, probably exactly what they cost patients now, depending on their insurance plan.
To understand a lot of the faults of the health care industry, one only has to look at the EpiPen. EpiPens deliver epinephrine, which can quickly save a person's life when they have severe allergic reactions (known as anaphylaxis). They may also be used for severe asthma attacks. Epinephrine, the drug, is pretty cheap. But the EpiPen, owned by Mylan, provides the perfect, pretty much foolproof delivery system.
It's this delivery mechanism that makes EpiPens a name brand with basically no competition. EpiPens have been around since the 1970s, and used to cost around $100. But Mylan came under scrutiny last year when patients started to notice that the price had gone up to over $600 for a two pack of them. Insurance companies noticed, too, and started charging patients out of pocket to cover the rising cost.
In the midst of the pricing scandal last year, Mylan blamed the ACA. They issued a statement saying that patients with "commercial insurance" have never had to pay for EpiPens but,
As the health insurance environment has evolved, driven by the implementation of the Affordable Care Act, patients and families enrolled in high deductible health insurance plans, who are uninsured, or who pay cash at the pharmacy, have faced higher costs for their medicine.
But just because Mylan blames the ACA, it doesn't mean that the repeal of President Obama's signature health care legislation will make the high price go away. Mylan only gamed a system that Obamacare exposed: Any Republican backed health care plan will always favor insurance companies and drug manufacturers like Mylan.
Under the version of the AHCA that passed in the House of Representatives earlier this month, there would be huge rollbacks in Medicaid funding for states. Which means that many patients who might not have felt the burden of the EpiPen cost — because they could afford to go see a doctor and get some of those infamous "EpiPen coupons" under the ACA — would not be able to get primary care covered, get their hands on those coupons, and find themselves writing checks at the pharmacy for a $600 EpiPen (if they can even afford that).
In addition to this, the version of the AHCA that the House approved allows states to decide what pre-existing insurance companies have to cover or not. Given the already very high cost of the EpiPen, it is likely that allergies that require an EpiPen would not be covered. Meaning that patients would have to pay more for their insurance policy overall or just pay more at the pharmacy, even if they can use the generic version of the EpiPen.
Because the Senate is still writing its very own version of a health care bill to repeal the ACA, it's too early to tell exactly what prescriptions would cost under the hypothetical plan. But any plan would likely mean that fewer people are insured and that insurance companies would be allowed to operate with fewer regulations. All of which doesn't bode well for lowering the cost of EpiPens anytime soon.