Epipens have more than quintupled in price since 2004

Translation: “Because we can.”

Until the rest of us make the shit ourselves (because a small operation certainly could) and pay a nominal royalty. Right, libertarians? Look it up in your Hayek, you fucking fucks.


A clear argument for IoT integration into future Epi-Pen™® versions: with ongoing reporting to the vendor and a crypto processor handling conditional access control you could make the system more complex and unreliable; offer just enough useful features to be insufferably smarmy about how this ‘innovation’ is actually good for your customers; and enable all sorts of exciting new business models.

In the tradition of the “free” carrier locked cellphone; you could offer ‘Epi-Access’(you would, in accordance with the smarm requirements, pitch this offering as an innovative solution to people’s problems affording medication): the up-front price of of the injector would be sharply lower than the standard list price; but if you actually had occasion to use it you’d be charged a substantial premium over the list price for the ‘service’ of enjoying the option of using the drug at a lower price up front.

Survival-As-A-Service subscription models would be another surefire winner: no per-use charge; but a constant monthly fee and deactivation of the client injection licences on any hardware you still had in your possession if you let your subscription lapse. With Epi-SaaS Basic, consumables would be authorized only for use on the subscriber. Epi-SaaS Family would cover up to five clients in a single household; and Epi-SaaS Premium would cover a single subscriber but allow them to assist others in need should they encounter them(as long as they aren’t employed in a capacity where this is part of the job; that means Epi-pen Professional or an enterprise site license, depending on a bunch of inscrutable variables you should contact our sales team about).

It’d be glorious.


As always: if a corporation can make $100 while harming nobody, and $101 while killing a hundred people, then a hundred people are going to die.

Profit-based healthcare is fundamentally, murderously unethical.


Can you just buy them? (Here in the U.S. there is a byzantine system where some things you can just buy ‘over the counter’, others require a prescription, some insurance won’t pay for, some require pre-authorization, some have limits.)

If someone can just buy them, then the obvious solution for anyone who needs them is to find a European to send them. (The extreme version of that would be to set up a benevolent smuggling ring. An international affordable health care cartel.)

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There are some competitors to EpiPen, but they haven’t caught on. The primary competitor, Auvi-Q, sold by Sanofi, was taken off the market in October 2015 because some of the devices weren’t dispensing the proper amount of medication.
A similar device, the Adrenaclick, was prescribed just a few hundred times last year, and a generic version was prescribed about 183,000 times, according to data from IMS Health. Since that device isn’t considered by the Food and Drug Administration as therapeutically equivalent to the EpiPen, it can’t be substituted when filling a prescription.
Teva Pharmaceutical Industries applied to market a generic EpiPen, but the application was rejected by the FDA earlier this year.

There seem to be two things preventing competition from lowering the prices.

It is difficult to make a device which is “therapeutically equivalent” to the EpiPen as judged by the FDA. Why? Is this a flaw in the regulation or is there something really special about EpiPens?

Alternative autoinjectors, which are not “therapeutically equivalent” to the EpiPen cannot be substituted by a pharmacy. The physician must write a prescription for a non-EpiPen autoinjector. Why aren’t physicians writing prescriptions for the alternative devices? Are they really that different or are physicians not sensitive to the patients’ costs?

I’m not especially needle-averse, but I can’t inject myself. Hands get shaky. If immitrex worked for me, you’d bet I’d carry around an autoinjector the size of a baseball bat if necessary. I don’t like going blind when a migraine hits while I’m driving. Terribly inconvenient.

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not sure about other European countries, but in the German-speaking countries (was the easiest to check, this covers Austria, Germany and Switzerland) epinephrine is a controlled substance and one need a prescription to buy/get such a pen.

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[expelative deleted]

Don’t give them fucking ideas. SaaS is so fucked up already, just don’t.

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Typically? No. I’ve had to cancel a surgery because my doctor couldn’t tell me how much it’d cost.

Me: “So, how much does it cost to get a toenail removed?”
Doc: “It varies.”
Me: “So, on average?”
Doc: “You know what? I don’t know. I’m not paid per surgery, and your insurance company determines that.”
Me (to insurance agent): “Is a toenail removal covered?”
Agent: “Is it medically necessary?”
Me: “It is if you don’t want to pay for crutches and PT, or possibly amputation in a few years.”
Agent: “You know what, we’ll tell you how much it costs when we get the bill.”



Fixed that for you.


There’s nothing special about EpiPens. Any attempt to make a ‘generic’ medical device faces the same hurdles. Hostile eyes looking at the design, the manufacturing process, and the materials all the way up the supply chain. It would seriously not astonish me if they dinged such a thing because Exxon substituted Louisiana crude for Pennsylvania crude when selling oil to the refinery that made the styrene that went to the plant that made the plastic that went to the injection mold shop that made the hard case that the pen is stored in. There is a whole ecosystem of certified suppliers that you can’t go outside without having to make them go through all the same hoops. Most of them are monopolies, because it’s so deuced expensive to establish and maintain compliance.


Given the last month, your increase seems quite restrained, really.

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Not really. It’s very expensive to document compliance, and what is actually required, in practice, is documentation (not to be confused with actual compliance).

In my (considerable) experience it’s cheaper to follow the HIPAA security and privacy rules than to not follow them - in fact I was following them before HIPAA was required… because it’s 99% just industry best practices. However, the amount of busywork paperwork required to prove compliance is very costly. GLB/SOX is the same way - if you’re doing it efficiently, you’re already doing it right, but the infrastructure required to maintain accurate legal documentation is very costly and very much impedes new market entries. And the purpose of the paperwork is, for all practical purposes, to make sure the top sociopaths are not blamed when someone discovers a compliance violation. The paperwork serves to shift blame from the boardroom class to the working class.

I’m actually a big fan of capitalism, but it is not the most effective way to deal with things like health care or state-mandated insurance. If an economic “ism” was appropriate to all ventures, we wouldn’t need government…


Cutting corners is absolutely capitalist in nature and which is why we need government.


We’ll have to disagree on that one. I know plenty of capitalists who see cutting corners as a good way to go out of business.

What we have now, thanks to regulatory capture and political corruption, isn’t really capitalism any more, it’s corporate feudalism. There is a hereditary aristocracy and steadily decreasing class mobility, and now with secret “no fly lists” being applied more and more widely there is also decreasing physical mobility, which prevents the peasants from voting with their feet. Cutting corners is a winning strategy in that environment, since fair market competition is being curtailed or entirely prevented.

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Your larger point is right, but Shkreli was far from the first.

My dog has a chronic liver ailment. She takes Ursodiol for liver support. Many elderly take it for the same reason. When she first started, it cost about $20/month. But after about a year, in the space of one month, the price skyrocketed to $700/month. Same reason. High profit pharma bought the drug from a generic manufacturer in order to milk Medicare. My dog was collateral damage.

Two years later, after Shkreli, the price dropped to $60/month and my dog can take it again.

I would argue the key difference is that Shkreli was milking a drug used by HIV patients, and there is a large, vocal community monitoring them. Nobody cares so much about old people and dogs with liver problems. Shkreli only did something that others have been doing for a long time. But he did it to a high profile community so activists paid attention.


Exactly why we went to training all of our people to use a regular old needle and vial. We have 20 or so fire department rigs carrying an adult and a child EpiPen, which expire every year. For less than the cost of one EpiPen we can outfit all the rigs with syringes and vials.


And yet those of scale don’t go out of business. Regulatory capture requires reform, not a lack of regulations and letting the insane run the asylum.

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No offense, but this is a No True Scotsman and Moving The Goalposts argument. What we have now is still capitalism–just effectively unregulated and highly monopolized capitalism. That’s the primary failure state of capitalism when allowed to progress to its end-stage results. There’s a reason why the sarcastic statement of “Late Stage Capitalism” when faced with these abuses has a sting to it.


No disagreement. But again, these are not inherent features of capitalism, they are features of the corporate feudalism we have now, where the goals of wealthy economic interests are legally privileged over the goals of society. In a well regulated capitalism, the reverse is true.

I didn’t [mean to] say it wasn’t. I said it is not necessary for capitalism to be this way. It is better for both capitalists as a class and for the rest of society when it isn’t, in fact.

Me and Adam Smith disagree; instead I’ll reference Plato and say that’s the primary failure state of representative government when allowed to progress past the optimal resource allocation state. Next step (again, according to Plato, who was admittedly an apologist for patrician government) is to elect a strong-man to fix everything, who will then become first of a series of tyrants. Vote King Trump the First, he will end Capitalism for you!

It’s babies and bathwater. People who can’t (or don’t want to) develop a nuanced view because a proper historical analysis takes hundreds of hours of study, will just paint all their troubles on a scapegoat, and say “it’s always this thing that causes all the bad.” Let’s knock this thing down, and then it’ll all be unicorns and rainbows.

In reality capitalism is acknowledgement that resources are unevenly distributed by nature, and trying to come up with regulations that will allow everyone to benefit from the human tendency to try to redistribute resources. A well regulated capitalism provides better living conditions and more technological progress than any other economic system; an unregulated capitalism is just nature, red in tooth and nail, and Murder Inc. always wins in that scenario.

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