By Nicole Dunn, JHBL Staff Member
More than 100 million people experience allergy symptoms in the United States each year.[1] Among these allergies, the number of reported food allergies are specifically increasing.[2] For example, the number of children with reported peanut allergies have more than tripled since 1997.[3] There are several theorized factors that have contributed to this increase.[4] For instance, in the last 35 years, changes to a human’s genetic make-up and the environment have led to a tenfold increase in adults suffering with allergies.[5] Additionally, food allergen avoidance, vitamin D deficiencies, and methods to help strengthen babies’ immune systems are all thought to have contributed to the increased incidence of reported allergies seen today.[6]
An unfortunate parallel to the rise of reported food allergies is the rise in cost of life-saving medical equipment and treatments.[7] For example, Mylan, a large drug producer, raised its prices more than 400% from 2008-2016.[8] The results from this increase create a real issue for those suffering from allergies and for parents that support children with allergies as they became unable to afford drugs at their increased prices.[9]
Specific costs associated with having an allergy may include purchasing epinephrine injectors, commonly known by their brand name EpiPen, seeing a doctor for immunotherapy shots, sourcing alternative food options, and doctors’ visits.[10] EpiPens alone cost $650, with the patient receiving only two auto-injectors.[11] There are some available, off-brand epinephrine injectors on the market, however, their costs are still prohibitively expensive for many people[12]
Further, immunotherapy injections, given on a regular basis to stop or reduce allergy attacks, can cost $600 per vial, with each additional vial costing upwards of $300.[13] To be effective, these injections must be administered one to two times per week during the buildup phase and require subsequent maintenance doses every two to four weeks for at least three to five years.[14] The costs for life saving medications and medical equipment like the ones discussed above produce about $25 billion in revenue for the national economy.[15] Even more staggering, an individual’s average cost of living with and treating their food allergies is reported to exceed $4,000 every year.[16] Yet, little help exists in American society to assist those individuals with their financial burdens.[17]
For parents of children with allergies, costs can extend beyond medical treatment.[18] For example, parents may need to buy food catering to their child’s specific dietary needs.[19] Additionally, parents in the workforce may lose productivity by staying home to care for their children experiencing allergy symptoms, leading to the potential for lost wages.[20] Parents with allergenic children must pay special attention to their children, make them special foods, and must often stay home to care for them or bring them to appointments.[21] Parents are also often in the best position to prevent allergic reactions or administer life-saving treatments, making it important for them to have the ability to be present and equipped with the necessary treatments.[22]
Insurance can help lower prices for families in need of epinephrin injectors and immunotherapy shots.[23] However, as of 2023, the average deductible cost in employer-based health insurance is over $1,700 per person.[24] Moreover, even with insurance, allergy medications are expensive.[25] This leads some switch to a high-deductible plan that comes with lower monthly payments.[26] However, despite the short term benefits of lower monthly insurance payments, users must pay thousands of dollars before the costs of many medications, including EpiPens, are covered.[27] Additionally, those seeking immunotherapy shots who are insured publicly by Medicare Part B can expect to pay the copay and 20% of the approved amount for covered services.[28] Accordingly, even with government assistance, immunotherapy shots can still cost more than $6,000 on average.[29]
Unfortunately, little has been done to directly lower costs for life-saving medications and day-to-day expenses for those suffering from an allergy.[30] There are some drug assistance programs that will help lower the costs of life-saving medications, however many of their eligibility requirements are extremely narrow.[31] For example, a Mylan drug assistance program for an EpiPen or generic epinephrin auto-injector does not apply if someone has prescription insurance coverage through Medicaid, Medicare Part D, or other insurance.[32] Thus, individuals are forced to choose between forgoing health insurance or receiving aid from these drug assistance programs.[33]
The lack of financial assistance for allergy assistance treatment, despite the continuous growth in the number of people with allergies, creates a dangerous situation where people are forced to choose between life and death.[34] Because of expensive insurance deductibles, high medication costs, and strict exclusions from drug assistance programs, many individuals opt not to purchase EpiPens or other life-saving treatments.[35] This decision forces them to risk their lives if an allergy attack were to occur.[36]
To curb these issues, we must advocate for policies that increase awareness of allergies and call for increased federal funding to aid allergies sufferers who could not otherwise afford life-saving medication.[37] Increased federal funding for U.S. federal agencies, policy, and programs that benefit people with allergies can allow for critical research to be done, which will improve individual care, expand access to clinical services, and address allergy triggers.[38]
Beyond prevention, policies that increase funding directly to families can ensure their ability to purchase allergen free foods.[39] This option helps many “at-risk” groups to secure safe foods and better manage their allergies.[40] Not only can this greatly improve the quality of life for those with allergies, but it could save the life of someone who was before unable to afford these lifesaving measures.[41] Thus, to keep up with the rising number of reported food allergies, the need for policies to increase assistance and funding for those suffering with food allergies and food allergy studies are essential now more than ever.
Disclaimer: The views expressed in this blog are the views of the author alone and do not represent the views of JHBL or Suffolk University Law School.
Nicole Dunn is a second-year law student at Suffolk University Law School. She graduated from The Ohio State University in 2022 with a Bachelor’s degree in Political Science.
[1] See Allergy Facts and Figures, Asthma & Allergy Found. of Am., https://aafa.org/allergies/allergy-facts/#:~:text=Nine%20foods%20cause%20most%20food,food%20allergies%20in%20the%20U.S.&text=About%2016%20million%20(6.2%25)%20U.S.%20adults%20have%20food%20allergies [https://perma.cc/YS3S-YD5G] (noting general allergies as sixth leading cause of chronic illnesses in the U.S.).
[2] See The Cost of Food Allergies: A $25 Billion Epidemic, Prevent Food Allergies, https://www.preventallergies.org/blog/cost-of-food-allergies-a-25b-epidemic [https://perma.cc/6A57-NAU3].
[3] See Lars Lange et al., White Paper on Peanut Allergy – Part 1: Epidemiology, Burden of Disease, Health Economic Aspects, Nat’l Lib. Med. (Sept. 28, 2021), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477625/#:~:text=The%20prevalence%20of%20peanut%20allergy%20in%20the%20United%20States%20has,world%20%5B11%E2%80%9313%5D [https://perma.cc/Uj6C-349T].
[4] See The Cost of Food Allergies: A $25 Billion Epidemic, supra note 2 (listing potential factors that caused increase in allergy diagnosis).
[5] See id.
[6] See The Cost of Food Allergies: A $25 Billion Epidemic, supra note 2 (listing theorized factors that have led to reported food allergy increases).
[7] See id.
[8] See Erika Edwards et al., More Families Facing Price Shocks for Lifesaving Children’s Medications, NBC News (Jan. 7, 2023)https://www.nbcnews.com/health/health-care/epinephrine-costs-not-covered-high-deductible-health-plans-rcna62956 [https://perma.cc/36ZH-HR93] (mentioning Mylan’s large price increase).
[9] See id.; see also Allergy Facts and Figures, supra note 1. Because of the financial burdens from special food costs, doctor’s visits, medications, and other medical expenses, parents are often unable to purchase epinephrine auto-injectors or other live-saving medication. See Edwards, supra note 8; Allergy Facts and Figures, supra note 1. Without these medications, children are much more vulnerable in the face of an allergy attack. See Edwards, supra note 8; see also Allergy Facts and Figures, supra note 1.
[10] See Allergy Facts and Figures, supra note 1 (breaking down costs of Epi-Pens and similar generic brands). EpiPens are epinephrine auto-injectors that provide a shot of adrenaline for anaphylaxis treatment. See Food Allergy, Am. Coll. of Allergy, Asthma, & Immunology https://acaai.org/allergies/allergic-conditions/food/ [https://perma.cc/964Z-RMVB]. Anaphylaxis can be fatal and occurs when exposure to an allergen triggers a flood of chemicals that sends the body into shock. Id. See Sana Khan, How Much Do Allergy Shots Cost?, GoodRx Health (March 21, 2022) https://www.goodrx.com/conditions/allergies/allergy-shot-cost [https://perma.cc/C7SE-VNSX] (explaining the price of immunotherapy shots).
[11] See Allergy Facts and Figures, supra note 1.
[12] See id. Off-brand injectors , meaning those epinephrine injectors not made by EpiPen, can still cost upwards of $400 per injector. Id.
[13] See Khan, supra note 10 (describing costs of immunotherapy shots).
[14] See id. (noting use of immunotherapy shots as way to gradually build immune system resistance against allergens). The build-up phase is the beginning of the administration of the immunotherapy shots and requires shots be given in closer time increments, building up immune system resistance. Id.
[15] See id.; see also Ruchi Gupta et al., The Economic Impact of Childhood Food Allergy in the United States, JAMA Network (Nov. 2013) https://jamanetwork.com/journals/jamapediatrics/fullarticle/1738764#:~:text=Overall%2C%20food%20allergy%20costs%20%2424.8,by%20families%20(%2420.5%20billion) [https://perma.cc/M853-2X5Z] (noting individual costs spent to maintain one’s allergy generates $25 billion yearly to national economy).
[16] See Gupta, supra note 15.
[17] See id. (finding need for data on economic impacts of allergies). To better allocate resources to preventions and treatments of allergies, policy makers must better understand its economic effect on individuals and the healthcare system as a whole. Id.
[18] See Allergy Facts and Figures, supra note 1.
[19] See id. (noting parents need to purchase special food and provide care for children with allergies).
[20] See id. Parents of children with allergies bear much of the economic burden for their children, often forgoing work for many days or, in more severe cases, choosing to stay home to care for them. Id. Parents may also spend more time and money buying and preparing special foods for their child with an allergy in order to keep them safe. Id.
[21] See id.; see also Edwards supra, note 8 (describing family whose yearly epi-pen costs jumped from $120 to $2,400 per year).
[22] See Allergy Facts and Figures, supra note 1 (pointing to parents as first-line of defense if their child has an allergy attack). Due to high costs of treatment, some parents have needed to forgo purchasing lifesaving treatments, making their children more vulnerable to an allergy attack. Id.
[23] See Edwards, supra note 8; see also Khan, supra note 10 (writing that insurance plans can cover large percentages of necessary allergy medication).
[24] See Edwards, supra note 8.
[25] See Allergy Facts and Figures, supra note 1 (describing parents’ choice between buying expensive allergy medication or risking bad reactions or hospital visits).
[26] See id. (noting families often choose to forgo health insurance because they cannot afford deductibles); see also Allergy Facts and Figures, supra note 1 (describing parents’ choice between buying expensive allergy medication or risking bad reactions or hospital visits). See also Edwards, supra note 8. One family that switched to a high-deductible insurance plan to reduce monthly payments in order to save money. Id.
[27] See id. One family’s epinephrine injector yearly expense jumped from $120 to $2,400 per year due to them switching to a high-deductible insurance plan. Id. This plan comes with lower monthly payments but takes years of payments before many medical costs are covered. Id.
[28] See Khan, supra note 10 (detailing costs of immunotherapy shots after insurance).
[29] See id.
[30] See Advocacy, Asthma & Allergy Found. of Am., https://aafa.org/advocacy/advocacy-resources/patient-assistance-medicine-drug-programs/ [https://perma.cc/GD2H-NJ79] (listing drug assistance programs).
[31] See Susan Hamilton, The New Food Allergy Law – Important Information You Need to Know, Simply Bus. (Feb. 7, 2022) https://www.simplybusiness.com/simply-u/articles/2022/02/the-new-food-allergy-law/ [https://perma.cc/D6TG-N8GQ] (describing Congress’s passage of FALCPA to prevent allergic reactions).
[32] See id. Drug Assistance Programs offered by Mylan for EpiPens or generic epinephrine auto-injectors only apply to those who do not have prescription insurance coverage through Medicaid or Medicare Part D and do not apply to those with private insurance, despite high deductibles. See id.; see also Edwards, supra note 8.
[33] See Advocacy, supra note 30; see also Edwards, supra note 8.
[34] See Edwards, supra note 8 (noting choice between insurance coverage or risks of death); see also Allergy Facts and Figures, supra note 1 (detailing parents unable to pay for medication due to financial burdens).
[35] See Edwards, supra note 8; see also Allergy Facts and Figures, supra note 1.
[36] See Edwards, supra note 8; see also Allergy Facts and Figures, supra note 1.
[37] See Federal Programs and Funding, Asthma & Allergy Found. of Am., https://aafa.org/advocacy/key-issues/federal-funding/ [https://perma.cc/F6HS-83Z8].
[38] See id.
[39] See Leia Minaker et al., Exploring Low-Income Families’ Financial Barriers to Food Allergy Management and Treatment, Nat’l Lib. Med. (Feb. 17, 2014), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945149/ [https://perma.cc/FWF9-HXEE]. A policy option that sends funds to families to help them obtain allergen free foods can be a large step in alleviating financial burdens of allergies. Id.
[40] See id. “At-risk” groups can include people like the working poor, newcomers, food bank users, and youth in poverty. Id. These groups tend to have a higher need financial assistance for medication and allergen-free foods. See also Minaker, supra note 39.
[41] See Federal Programs and Funding, supra note 37; see also Minaker, supra note 39.