A couple of reasons. One is because there are laws in place that force insurers to cover all available drugs and that they be available to everyone. That leaves very little bargaining room so the pharmacy companies can pretty much charge whatever they want.

Other countries that have the freedom to say no to certain drugs can negotiate down the costs. Individual hospitals in the US can refuse to write prescriptions for certain drugs and that can help to an extent.

Another is that many pharmaceutical companies have intellectual property rights, which means they can basically set the price. The information on how to produce the drug is hidden and can't be produced in cheaper, generic form.

To be fair to the pharmaceutical companies though, it is VERY expensive to come out with a new drug. Hundreds of millions to billions of dollars for EACH drug that makes it to market. Many fail in the testing trials and that's costly. They have to get the capital from somewhere, though I do agree that some of the prices are completely out of reach for many people. I don't see that changing anytime soon with our pill-popping society.

chi, no offense, but I don't think your answer is what the poster was looking for.

Kathy, I hear you on the robbery costs for medications. The medication my husband needs to stay in remission from his cancer is $200.00/pill and he will need it or some other expensive drug every day forever.

Below are a couple of links for help with copays, the first is the EpiPen website, if these don't help, there may be some other co-pay assistance programs available.

Copay assistance

2nd Copay assistance link

I am not offended but I think that was a bit rude of you to say.

She said, "how can these pharmaceutical companies raise prices by that much" so I believe my answer to be relevant regardless of whether the statement was rhetorical or not. Understanding the rationale behind something is often helpful when something seems outrageous.

Lukki, thanks for those links. My grandson needs epipens and I passed the links on to his parents.

Lukki, not sure why you said chi's answer wasn't what the OP was looking for. I think chi was offering the "logical" reasons for the high prices. OP doesn't specify whether she wants only more outrage or an actual possible explanation.

But here is my answer: It takes A LOT of money for these gouging, greedy companies to buy members of the US Congress. Corporate profits continue to be at record highs, with those highs continuously growing, while wages for most people have been stagnant. So not only are they charing us a fortune (while cutting back on quantity and quality in order to boost those profits even further), wages for workers are stagnant and have been for the past 40 years. Thank you Trickle-down economics and the too-long era of worshiping greed, the obscenely wealthy, excessive wealth for a few, and a cynical corporate culture.

Too many fingers in the medical industrial complex pie. It takes how many people just to process your insurance premium? 142? The insurance company, the HMO, the company that administrates the billing…

Ultimately, the answer to your perhaps rhetorical question is: Greed, inefficiency, and corruption.

Part of the specific reason for Epi-Pen to have gone up in price so much is that they now have a competitor that recently came to market, so they now are running an ad campaign to try to maintain their market dominance over this newcomer, additionally they have had to pay lawyers over the past several years to file motions and lawsuits to attempt to prevent, or at least delay as much as possible, this new competitor.

See http://blog.onespotallergy.com/2013/02/mylan-lashes-out-at-sanofi-only-two-weeks-after-auvi-q-launch/

So while the reasons chi83 lists are the rationale that have long been offered to explain high prices, I think increasingly they are better considered rationalizations (meaning reasonable-sounding explanations that while true, are only a small part of the truth.)

In this case though the drug development costs are zero, since the product has been available for nearly 30 years, and the medicine it contains was commonly used well before that, and was first synthesized way back in 1904 (according to wikipedia) so the true reasons in this case are probably pretty much in line with those tibbrix offered.

I just look at it as a celebration cost. Yay! Another year I didn't need the pen! Woohoo!

bob, did you get a chance to ask your wife if the other one can be carried in a pocket fairly easily (and/or safely)? I do carry it in my purse, but there are times, like out bicycling, hiking, etc. I'd like to have it in my pocket.

What I dont understand is why they sell a 2 pack. Most people wont even use the one, but they only come in two pack then when they expire you have to buy two again. Of course they get to charge more when selling two. You can try to say have one in your car and one at home, but one in your car is fine because if you are at home, your car is also.. and if you really need to have it all the time you will carry only one.

Anaphylaxis is serious stuff. A backup makes loads of sense to me. In case of mechanic failure or other problems I can't think of right now.

bob-cville, so much for competition creating downward price pressure!

When you are about to fill or refill a prescription, first talk to your pharmacist (not your doctor) to see if a generic is available. Then get your doctor to prescribe the lowest costing drug.( I say talk to your pharmacist, because they are experts on drugs, dosages, etc. )

why not the doctor? I could swear, the prescription has to come from them? Seems like mine fills it out as "generic when possible". Something like that.

I am lucky and get my epipen through my insurance for a reasonable fee. But, it comes in a two pack. Since I really never use my epi pen it is such a darn waste. Both expire on the same date, and when I requested to get only one, I was charged more. What the heck?

Moni

Okla…reasonable fee? What is your insurance premium?

There is no such thing as a "reasonable cost" when it comes to health care in the US now.

What type of expiration date are you folks seeing with Epi pens? My grandson has to have one at school and one at home and my daughter says that the expiration is always less than a year and it's so expensive even with insurance.

Ive been saying it all along. Instead of gov't trying to provide insurance to everyone they should have different cost tiers for hospitals which limits what they can charge. If you have the best care system / most advanced care system you get a higher tier and can charge more but there should be limits. Obviously the cost of health care just keeps skyrocketing and will continue because it is the only thing in this world that everyone needs. So instead of limiting the ridiculousness they try to pay it for everyone. Makes a lot of sense. I am not against hospitals, I agree that docs and healthcare workers have learned a lot, have special skills, and should be paid for it, but there is too much money flying around going to investors and board members.

Possibly the constant increasing cost of college is causing healthcare to rise because docs spend so much going to school then they want more when entering the work field and employers eventually raise their pay to fill positions, that and private practice docs may be charging more to handle their bills as well.

Healthcare costs are rising because of an aging population. We're living longer, but it's because we are able to maintain diseases that killed us years ago. So there are more costs to maintain than existed before too. We're more obese than past decades, which causes concomitant health disorders (diabetes, heart disease, wear and tear on joints...). There are more reasons, but these are the main reasons.

That doesn't mean pharma doesn't need to cut its costs, it does. They are the ones who are pocketing that profit, not hospitals.

Chi - as I said, not to offend. Her post is an obvious vent. Most people dealing with a chronic illness already understand why costs are the way they are.

Tibbrix, I wasn't rude in the least so go scold someone else.

Oly, I really hope it helps and they are able to arrange for some financial assistance.

rob333
I saw the package which was about the size of my flip phone cell phone. So logistically it can be carried in a pocket, (meaning it would fit) I also know it has a safety cover so it wouldn't self-activate in your pocket. I don't know whether the temperature of a pocket would be detrimental to the medicine.

Lukkiirish, if you have to preface a comment with "no offense," then that should be an indication to you that the comment is rude. Otherwise, you would have no need to say that. And adding "no offense" doesn't actually take away the offense, by the way.

In any case, several other posters have also gone into discussion on the cost structure and the various reasons for it, so obviously people are finding value in the discussion. Discussion boards are for everyone, original posters, participants and audience alike. It's not up to you to decide what is relevant and what isn't when people are making an effort to contribute in a positive way.

that helps bob! Temperature shouldn't matter because it wouldn't be all that often. I'll ask at my next appointment when I go in another 23 days.

I have read that many people will keep the pen-shaped unit in their car's glove box, and that because a car's interior temperature can go up to 130 deg F in the sun in the summer, that the medicine can be negatively affected.

Lukki, I didn't call you rude! Please re-read my comment.

The OP called you rude.

Tibbrix, you didn't need to respond to my comment at all and I'm really surprised as to what the confusion is as to why I said that. Much to Chi83's disagreement, which is fine he/she can make any assumption about my intent he/she wants (I really don't care), my point is anyone who is faced with a hike like that for medications needed to survive is going to be shocked, upset and scared. When faced with that kind of situation, would you really need the text book explanation on economics explained to you (as if you don't already know) or would you really be looking for empathy or even some help in finding a solution to your situation? I'm just saying...

Lukki, just as you responded to Chi's comment in the way you saw fit based on how you read what she wrote, I responded to yours. I didn't need to. I wanted to. No one needs to respond to any comment here. We want to do so. Whether she was looking for the technical reasons for the high costs or not is not relevant. You wouldn't know any more than I what kind of response she would be looking for. Very often, the cold, hard, facts kind of response is actually the most comforting as logic can put things in perspective.

Regardless, the immediate issue is that you accused me of calling you rude, followed by a request that I go scold someone else. You accused someone of something they did not do, which is less acceptable than responding to a "rant" with logical level-headedness. It's also somewhat ironic since you were scolding Chi for, in your opinion, not responding in a way the OP wanted. I wasn't scolding you at all. This is all I said to you: "Lukki, not sure why you said chi's answer wasn't what the OP was looking for. I think chi was offering the "logical" reasons for the high prices. OP doesn't specify whether she wants only more outrage or an actual possible explanation."

I don't see myself even implying that you are rude or that I am scolding you there. I don't even see anything remotely controversial about what I wrote there. To offer another perspective is not scolding.

But, I don't like being accused of things I do not do. Indeed, you don't even acknowledge in your latest response that you erred by doing that and in fact you continue to be defensive, telling me I didn't need to respond at all, etc.

Own up to having made a mistake and move on. But when you make a mistake like that, wrongly accuse someone of something pretty negative, you have an obligation to acknowledge it and fix it.

OP here. Thanks one and all for the comments and links. Lots of differences of opinions.

I can afford the Epi pen, I do not want to have to pay that amount of money for it, but I will. My doctor wants me to carry it with me one day a week when I have my allergy shot.

I really feel bad for the people who do not have the money to pay for something that last year cost $25 and has now gone up to $200.

I take 14 different prescriptions and if all of them jumped in price like the Epi pen I would have to pick and choose what meds I really felt I needed. Some of my meds are $100 for 3 months, but most are much less.

My rant is mostly for those who cannot afford these costs. Not so much for me.

Thanks all, Kathy G in MI

Kathy, it's not about whether some can afford it and others can't. It's the fact that these things are WAY overpriced, yet they are needed to save people's lives.

I was paying $8, the next time it was $45, the next time it was $360. Not too much you can do about it, I tried.

I'd pay thousands if I needed to. I am not about to dally around with my life. I think it's an outrageous cost, but I can justify having the backup in many more ways than the downside of the cost. I've been fairly poor for a long time, and I still save for it.

Bob, always in my purse, my medicine cabinet, and at work in the first aid kit. So I am safe on keep it cool ;)

I have two kids with peanut allergies so we have carried epi-pens for years. With a previous insurance company I paid about $100 for them, but now around $30. This past year we were in the emergency room twice and by far I would rather pay the extra than to go through what my daughter did . Hopefully I will not be in for a surprise when I refill for new ones when school starts again. I have been seeing lots of commercials so I am glad a link was made.

jewels if you don't mind me asking (if you do please just ignore this) were the er visits because of peanuts? If so, did anyone use the epipen on her before her trip to er? I'm asking because my 5 yo grandson has pnut and some other severe allergies (he just went to the er for the first time when they were visiting a dude ranch and he apparently has a severe allergy to horses)! I am always fearful that I will have to make the decision to use the epipen, although I am really careful about what he eats. Just don't know what other things are likely to crop up besides horses. Thank you.

The first time we ended up in the ER we were at a wedding and my two girls went to get a piece of the cake and it never crossed my mine that the grooms cake would have peanut butter frosting. We were very close to a hospital so we went right there. She threw up alot, sneezed a lot and had lots of tummy pain. A few months later she was eating a cookie at school and for the first time that year they made peanut butter cookies and did not have cards identifying the type of cookie. The nurse did tell me that she was just about to give her the epi-pen before I got there. We live close to a hospital so I took her there too, but it wasn't as bad as the first time. Me and my daughter have had to have a serious talk about not putting anything in her mouth unless she knows what it is. She is 16 and got rather careless. My son reacted really bad one time at a horse ranch, but he was just watching my daughter ride standing at a fence. His whole face turned red and tons of snot. My biggest advice is to educate your self about when to administer it and remember he still needs to have medical attention if you do. I'm getting ready to leave for a bbq but feel free to ask anymore questions.

Thank you. I can't believe that any school would have pnut butter anything these days. Same with a big party where there will be kids. There are so many kids with pnut allergies, it seems reckless to me. I'll think about more questions and maybe post after the weekend. I'm glad everything turned out ok for your kids.

Oly, there are plenty of kids without peanut allergies. Children with peanut allergies need to LEARN to avoid them, as peanuts are everywhere in the world and no one will shelter them when they grow up. The largest reactions are the first time when they dont know they are allergic. The next time it happens they know what is going on and can alert someone and prepared action can be taken. Dont try to standardize everything. For example, why do you think common core came to be... got to be the stupidest and most over-complicated way to perform basic math. People messing with things that dont need to be messed with. *sigh*

Well, common core isn't a life threatening situation, where peanut allergies can be. There are so many options besides peanuts that could be used. Deliberately exposing children in public schools to something that is highly dangerous for a growing number of kids seems reckless to me. Some kids don't even need to ingest p'nuts to be affected. Many schools prohibit all peanut products, even in home packed lunches. Seems prudent, but then one of my loved ones is at risk.

Drug companies are in business to make money. Our government, unlike other countries, does not get involved in pricing. We have very serious drug shortages because companies stop making drugs that are not profitable.

To some posters

Unless you live in a cold climate, please do not keep your epi-pen in the car. Epinephrine is very sensitive to heat, which can make the drug much less effective.

For expensive drugs be sure to pharmacy shop. Some drugs are least expensive @ Costco (you do not need to be a member to use their pharmacy), others @ Walmart, and others @ Walgreens. Call and ask for the price.

@ PK, if a pharmacy gives you an epi-pen with less than a year expiration, ask for another/newer device. They may have old stock on their shelves.

While the epinephrine is "generic," the autoinjector is not. The cost for an ampule of epinephrine and a syringe is well under $2.00 - it is the autoinjector you are paying for.

While it may be expensive, I have seen children die because their parents did not carry an epi-pen. Very sad.

Your first paragraph is true, but I think that when phrased in less neutral language it is a little more true: Drug companies are in business to make money. They intentionally manipulate the supply to create very serious drug shortages, so they can sell the drugs for a greatly increased price. Our government largely turns a blind eye to such actions and has even passed laws that prohibit Medicare from negotiating prices of drugs.

For those who have young children with peanut allergies:

I am recounting this situation because it may help in terms of making sure your child is protected. I was a school nurse for many years. One of the elementary schools I worked for had a large after school program. I suggested to the principal that she let me teach about allergies and pens at a faculty meeting, she dragged her feet and never scheduled me.

I'm not a quiet person when it comes to my kids and made a lot of noise, and there was some friction between me and the principal over the situation. Finally she sent the head of the after school program to speak with me, I identified those children in the program who might need an Epipen and showed him how to use one.

The VERY NEXT DAY after school, a substitute was taking care of an after school class, and they had peanut butter snacks. The child in question refused, but the other children apparently forced consumption by putting the snack in her mouth against her will.

She told the substitute, who thankfully believed her, and the after school program manager administered the Epipen, apparently there were already symptoms by the time he got it out of the locked cabinet.

Instead of thanking me for my concern and persistence, the principal ordered the after school manager to keep quiet about the situation, I found out via a teaching assistant who was a friend.

Don't assume because there is a nurse and your child has a pen at school, that your child will be protected. It is worth the time to think through possible situations: substitutes, field trips, after school activities. And don't be afraid to be loud, if quiet doesn't get it.

Those compounding pharmacies are not needed. Doc tells the nurse what he/she wants and the nurse pulls the supplies for injection. It literally takes a doc maybe 1 extra minute to mix their flavor of steroid themselves via small vials straight from the manufacturer. It is not worth the risk to inject something you aren't completely sure is sterile, or the correct mixture, or even the correct drug in my opinion.

No not kidding, they come in around 10mg vials. Taking out a middle man is a better route imo. Plus you can adjust the dose to the patient easily.

And yes there are pills that have mixed drugs, but that gets done at the mfg also.

If there are recalls, it just makes it easier to pull the recalls you have than to try to track down info from a compounding company.