Painful sting leads to a painful prescription-drug lesson  

Well-known Rappahannock artist Geneva Welch was stung twice last week.

The first sting was that of a yellow jacket wasp, which came as she did a few housekeeping chores on the deck of her Flint Hill home a week ago. Although she’d been stung by a bee a couple of weeks earlier and suffered just the usual local swelling and itching, the yellow jacket sting caused an immediate, systemic allergic reaction, known as anaphylaxis, a life-threatening condition.

Geneva Welch, back at her gallery on Main Street in Washington Monday, discovered the high cost of EpiPens after a wasp stung her on the wrist last week.By Roger Piantadosi/Rappahannock News
Geneva Welch, back at her gallery on Main Street in Washington Monday, discovered the high cost of EpiPens after a wasp stung her on the wrist last week.

It had been some 20 years since she had such a reaction, though she recognized it immediately and called her husband, Roger Welch, who was manning the store in Washington (the Geneva Welch Gallery); he  got in the car and headed north.

As the swelling and burning increased through her limbs and started to affect her lips, tongue and throat, Geneva said she drove out the long farm driveway to meet her husband; they reached Warren Memorial Hospital in Front Royal while she could still breathe, though she couldn’t talk, and the emergency-room staff took her without delay and started the intravenous adrenaline application that stopped the reaction.

The second sting came, on the way home from the hospital three hours later, when she went to fill the hospital’s prescription for a two-pack of EpiPen, the medical device for auto-injecting a measured dose of epinephrine (adrenaline). It is carried by school children with food allergies and others who run the risk of allergy-related anaphylaxis episodes on the road.

The EpiPen pack was just over $600.

“You just can’t believe it,” said Welch, who is fine now and back at the gallery, though she says “I probably won’t be doing a lot of plein air painting this season.”

The last time she’d purchased an EpiPen, probably in the early 1990s, she said, it was about $50.

Thus the Welches discovered that the price of EpiPens has risen some 400 percent in the past several years — as others have been discovering, coincidentally just in the last week, and protesting to such a degree that CEO Heather Bresch of the drug maker Mylan, held a press conference and several interviews earlier this week to defend the company’s pricing.

U.S. senators, including Virginia’s Mark Warner, and Democratic presidential nominee Hillary Clinton, had begun putting public pressure on Mylan just last week. Bresch blamed the complex array of middlemen — wholesalers, retailers and pharmacy benefit managers — in part for the price rise.

The company would create a generic brand, Bresch told CNBC, which would cost about half the current $600 retail price. It would also increase the availability and percentage of discounts, she said. Clinton’s campaign said the company’s plan was “insufficient.”

“If that happens,” said Welch, who decided not to fill the EpiPen prescription this week, “I might get one, at that price, at $300. But the first thing I’m going to do, when it comes time at the end of the year to choose [my Medicare prescription drug supplement insurance], is find out who offers the lowest price for EpiPens.”

The chief medical officer at one of those prescription drug insurers, Express Scripts, told CNBC this week that Bresch’s claims that the middlemen were responsible for the high price “couldn’t be farther from the truth.”

“If she wants to lower the price she can lower the price today,” Dr. Steve Miller told CNBC, adding that Express Scripts’ copays for EpiPens have risen less than 50 cents, from $73.03 to $73.50, in the last 18 months.

Welch said she told her story on the phone to an aide in Sen. Warner’s office this week, and spent hours on the phone or online with insurance companies, Mylan representatives and others who offered “coupons” which would supposedly lower the cost of the EpiPen — but, when presented at the pharmacy, did not.

“In one case, it was more,” she said.

For now, Welch said, she’ll try to get by with $60 worth of wasp spray she and Roger bought the day after the incident.

“By the time Congress, or Mylan, does something, we will have had the first frost, and it won’t matter until next year,” she said.

“But it’s such a scary thing,” Welch added. She was talking about the allergic reaction to the wasp sting — but regarding that second, financial sting, she also worries.

“Things are just so discouraging and bizarre these days,” she said. “People used to do things to be helpful and proud. You know, I was told that in private schools — I think public schools still provide it — but in some private schools, if your child needs EpiPens, the school requires the parents to pay for it up front.”

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