The EpiPen Exploits

Three bites into dessert and I feel it: an unmistakable scratchiness in the back of my throat, the tingling sensation in my lips, and swelling of my eyelids. Those with allergies can relate. A closer inspection of my ice cream cup reveals hazelnuts in the nougat sauce. My face continues to balloon, and within minutes, I am unrecognizable. What followed next was a blur: a call for an ambulance, frantic texts to my parents, and the suggestion that I use my EpiPen. I stubbornly refuse any such suggestion. My reasoning: I don’t feel like my throat is closing, and EpiPens are too expensive to waste.

In 2022, Viatris (formerly known as Mylan) offered a $264 million settlement for a class action lawsuit alleging the company monopolized the market for epinephrine injection devices, commonly known as EpiPens. The settlement ended a near decade-and-a-half-long legal battle over Mylan’s choice to raise the price of EpiPens from $100 to $608 in 2007. Pfizer — the parent company of the manufacturers of EpiPens — denies any such scheme, but the company “believes this settlement is in the best interests of the company and its stakeholders,” according to Viatris’s quarterly earnings report from February 2022.

According to CNBC, it costs only several dollars to make an EpiPen. Yet, Mylan recognized the demand for their device and the lack of alternatives. They knew they could charge whatever they wanted for a tube of plastic and people would pay for the two milliliters of life-saving medication inside.

Prior to the settlement, I received a letter in the mail with details of the lawsuit and instructions as to how I could receive compensation. Of course, that process required jumping through a series of hoops, asking me to provide documentation of my family’s purchase of EpiPens, which I did not have on-hand. I had been buying EpiPens for 15 years — it was practically a habit.

We first learned I was allergic to nuts at my first birthday party where, upon eating my first few bites of cake, my face erupted in splotchy hives. Rounds of testing revealed I had moderate allergies to peanuts and eggs, which eventually turned into a sole allergy to tree nuts. I was never anaphylactic (deathly allergic), but the medical advice was always the same: carry an EpiPen just in case.

This kick-started years of buying and replacing EpiPens as they quickly expiredconvinced to maintain this habit by horror stories of children who went to school or went camping and died due to moderate allergies that suddenly turned fatal. If only they’d had an EpiPen with them. So my parents, just like thousands of others, paid exorbitant amounts of money out-of-pocket (because, of course, insurance does not cover EpiPens) for medication we would hopefully never have to use.

They knew they could charge whatever they wanted for a tube of plastic and people would pay for the two milliliters of life-saving medication inside.

The monopolistic pricing abuse by Mylan mirrors that of Eli Lilly, the drugmaker that sells insulin. Over several decades, Lilly raised prices on insulin by more than 600%. Insulin is also cheap to produce. A dose generally costs less than $10; yet, according to an article from Vox, some versions of the drugs are listed at over $200. However, unlike people with allergies, diabetics — of which there are nearly 30 million in the U.S. — need insulin at all times to stay alive. Though Eli Lilly recently announced it would set a price ceiling of $35 per year on outof-pocket payments for insulin, many are still outraged. According to an article from the New York Times, the policies may not even affect what people actually pay.

For years, people have lamented the exploitation being done by medical manufacturing companies. In a 2016 blog post for Health Affairs, professor of economics and public affairs at

Princeton Dr. Uwe E. Reinhardt explained that the practices of Mylan and Lilly fall under “savage capitalism.” Using the words of famed economist Milton Friedman, Reinhardt explained that under savage capitalism, a for-profit company’s sole obligation is to “maximize its profits while engaging in open and free competition without deception and fraud.”

He urges for more ethical customs in corporate management, calling out Mylan’s CEO and other pharmaceutical companies. “Failure to appreciate this ethical constraint may impair not only the corporation’s image, but that of the firm’s entire industry,” Reinhardt said.

Seven years later, companies like Eli Lilly and Viatris are finally changing their practices, hoping to paint their public image in a more positive light while also refusing to admit any wrongdoing. What these companies have done is prey upon people with an already strained relationship to food due to unalterable afflictions and exacerbated it with outrageous medical bills, simply because they can.

For those wondering, I never used my EpiPen during my ice cream-induced allergic reaction during the summer of 2021. Instead, I was administered epinephrine intravenously during my ambulance ride to the hospital. I spent six hours under observation after determining that my throat was not closing, despite my pufferfish face. Fortunately for me, I was in a country with socialized medicine. The whole hospital ordeal didn’t cost me a cent.

Celia Rattner ‘25 studies in the College of Arts & Sciences. She can be reached at crattner@wustl.edu.