The EpiPen Scandal

The EpiPen and the Senator's Daughter

A $30 device became a $650 device. Nobody went to jail. Here's what happened.

You may remember the EpiPen story. If you don't, it's worth knowing — because it's one of the clearest examples on record of how pharmaceutical pricing works when the people setting prices have the right connections.

How the Price Goes From $30 to $650

Mylan Pharmaceuticals acquired the EpiPen through the purchase of an auto-inject device originally manufactured by Pfizer. After the acquisition, Mylan told Pfizer to stop producing their version. Mylan would be the sole manufacturer going forward.

Then the price changes began. The EpiPen, which had been selling for roughly $30 to $50, was repriced over the following years until it reached approximately $650. That's an increase of more than 1,000 percent on a device that delivers a dose of epinephrine — a medication that costs pennies to produce.

Epinephrine is not a new drug. It is not a breakthrough. It is one of the oldest medications in existence. What changed was not the science. What changed was who owned the delivery mechanism and what they decided to charge for it.

The CEO Running the Company

The CEO of Mylan during this period was Heather Bresch. She was the daughter of Joe Manchin, at the time a United States Senator from West Virginia.

Senator Manchin had relationships with members of Mylan's board. His daughter joined the company and rose to the top of it.

This is not speculation. It was reported widely, scrutinized in Congressional hearings, and was part of the public record. What followed the price increases — racketeering allegations, price-fixing lawsuits — did not result in criminal charges. Those cases were resolved or dropped. Heather Bresch eventually resigned from Mylan with a compensation package reported at approximately $30 million.

Who Pays for This

People with severe allergies to bee stings, shellfish, peanuts — anyone whose allergic response can become life-threatening within minutes — carry an EpiPen because the alternative is dying before an ambulance arrives.

When the price of that device crosses $600, a meaningful number of families start rationing. They carry an expired pen because they can't afford a replacement. They carry one pen when they should carry two. Some carry none.

The device costs a few dollars to manufacture. The epinephrine inside it costs almost nothing. The $650 is not covering research or innovation. It is the price of a monopoly on a life-saving product, set by people insulated from the consequences of that price.

Why This Keeps Happening

The Shkreli situation — raising the price of Daraprim from $13 to $750 — got enormous attention, and he ended up in federal prison. The EpiPen situation drew Congressional hearings, a $465 million settlement with the Department of Justice for fraudulent Medicaid billing, and no criminal charges.

Different outcomes, same behavior. The difference, in many cases, is who you know and how well-positioned your lawyers are.

Patent manipulation, restricted distribution agreements, acquired monopolies — these are the instruments. Political relationships are the protection. The people who can't afford the medication at the end of the chain are the ones absorbing the cost — financially, and sometimes with their lives.

I'm not in the business of telling people how to vote. But I do think there's value in being clear-eyed about what's happening and who benefits from it. When the same political class that could change these pricing structures is receiving contributions from the industry setting them, the dynamic is worth understanding.

The Lesson That Actually Applies to You

Most of what I've described is outside your direct control. You can't fix pharmaceutical lobbying from your kitchen table.

What you can do is reduce your dependence on the system. Not by ignoring medicine — but by addressing the conditions that put you on five medications instead of zero.

Blood pressure that responds to weight loss doesn't need a daily pill. Diabetes driven by insulin resistance can often be reversed through diet. The fewer chronic conditions you're managing, the less leverage the pricing structure has over your life.

That's still the best exit I know.

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