Why does Mylan keep raising the price of the Epi-pen with impunity? Because it can.

It’s just economics, folks. Mylan holds a monopoly on the product.

It’s been more than ten years since we’ve had to use an Epi pen on my son, to reverse a life threatening allergic reaction to peanut. A routine visit to the optometrist turned hellish when he wandered over to a vending machine that dispensed Reeses bits and M&Ms and helped himself to a fistful scattered on the floor. His tiny fists couldn’t have held more than five or six candies, but he needed only a sliver of one Reeses bit to throw him into anaphylaxis. Within seconds, his face turned bright red and puffed up. In under a minute, his entire body swelled to the point where his underwear bit painfully into his waist and thighs. I did not recognize my child. Then the vomiting began. My two other elementary aged children stood over their convulsing sibling, stunned into silence as I rummaged through my overstuffed handbag to find the Epi pen. I’d never used one on my child before and in that instant, all the practice rounds with the Epi pen trainer abandoned me.

But wait, there was a doctor in the house. Turning to the receptionist, I asked her to get the optometrist. When she returned, it was to say this; He doesn’t want the liability. He can’t help you. But I can.

She got on the floor beside me and held my child while I swung the auto injector into his outer thigh.

That day I learned a few valuable lessons. The more important of which was this: Carry more than just one Epi pen. Why? Because one is often not enough. It temporarily reversed his reaction and bought us time – 12 minutes – to get him to a hospital. That day, it took another dose of epinephrine and a shot of Diphenhydramine, the active ingredient in Benadryl, before he was cleared to go home. Even then, the doctor cautioned us to stay vigilant through the night because a second follow-up reaction could happen

We’ve filled a prescription for two Epi-pen 2 Paks ever since and have watched the price climb. That’s four Epi-pens a year. My son self-carries his Epi-pen during the school year. The school nurse keeps one on hand, I carry one in my handbag and the fourth is for a sibling or my husband to carry when he’s out with them.

However there was a brief period between 2013 and 2015 when Mylan, the makers of the Epi-pen, had competition and their product was affordable. Like Mylan, Sanofi US launched the Auvi-Q in two strengths, and Mylan’s twenty-five year monopoly ended, albeit briefly. Even though insurance companies were not covering Auvi-Q, allergists were giving away free samples. Mylan followed suit with coupons that at one time dropped our cost to under $50 and at another time covered it 100 percent.

In October, 2015, Sanofi, in response to 26 reports of suspected device malfunction, recalled the Auvi-Q and Mylan was top dog once again.

Last year, I paid $256 for a twin pack of the Epi-pen and that was with insurance. I made sure the expiration date was at least a year out.

Nevertheless, for every year my son’s Epi-pens are unused, I consider it our good fortune. I don’t put a price tag on our overwhelming relief that we’ve gone another year without an emergency room visit to reverse a life threatening reaction.

That’s what Mylan, the makers of the Epi-pen, are counting on; our collective relief when we buy, but don’t use their life-saving product. Gosh darn it, we don’t have a choice, do we?