The EpiPen costs 88% less in the UK than in the US

In the US, an EpiPen two-pack has a list price of $608, up more than 500% over the last decade. In the UK, it costs roughly $69.

That’s what Mylan says it pays a manufacturer to make for two pens here in the US.

The US tends to have the highest drug prices in the world, for a number of reasons.

In the UK, that $69 per two-pack of the device, which is used in emergencies to treat severe allergic reaction, is paid by the National Health Service, a publicly funded health system. In the US, there are both public and private insurers.

The UK also has a more competitive EpiPen market: two other auto-injector pens are available there that haven’t been approved here in the US, Bloomberg reports. In the US, competition hasn’t done much to drive down the cost of the EpiPen, as it still makes up the vast majority of prescriptions.

And, as Mylan CEO Heather Bresch pointed out in her congressional testimony, families in need of the EpiPen weren’t intended to ever pay the full $608 price. Between insurance and savings card, it should have been much lower.

But Americans are starting to be on the hook for a lot more of their medical expenses than ever before: A recent Kaiser Family Foundation survey found that deductibles, the amount of money a person with insurance has to pay before the insurance company steps in and covers a big chunk of it, had gone up 20% in the past five years. Separately, 77% of Americans who responded in a recent Kaiser Health Tracking Poll said they thought prescription drug costs are unreasonable, up from 72% thinking that the year before.

Mylan said it makes $160 in profit off each EpiPen two-pack before taxes in the US. In 2015, its gross margins on the product here in the US was 72%, according to a table the company sent to Congress.

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