Rising price of naloxone restricts accessibility

By Noor Adatia
BU News Service

While naloxone effectively reverses the effects of an opioid overdose, medical experts said the rising price of one form of the drug may limit overall access to the life-saving medicine.

Opioid overdoses remain common throughout Massachusetts, and in Franklin County, the number of prescriptions for Narcan ranks fourth-highest among counties nationwide.

In Massachusetts, naloxone is most commonly administered to people with an opioid overdose using a nasal spray known as Narcan. There is also an auto-injector option, though less common, that can be used to bring people back to life.

Kaleo, the company that manufactures the auto-injector form of naloxone, has been selling Evzio for over $4,000 per dose this past year – a dramatic increase from its initial price of $575 in 2014.

How naloxone works

“So people start breathing again,” he said. “They wake up and start breathing.”

Even though most people who need naloxone have addictions, people who take prescription opioids for pain also could be at risk of overdose. Since there isn’t always a health professional available when people overdose, the process of providing treatment has to be easy enough for people who lack training.

In the nasal spray form, naloxone enters the bloodstream through the lungs. The injector version is absorbed intravenously, usually on the outer thigh muscle.

After activation, the auto-injector also provides verbal instructions to the person who administers the shot, dictating necessary steps including where and how to place the needle.

In the public health community, experts have generally moved towards the nasal spray “because there isn’t any research that says one is better than the other.”

“For lay people, the idea of putting something into somebody’s nose and spraying it seems more comfortable for folks than an injection with a needle,” Saitz said.

The auto-injector is often considered surer and more preferable by people who may have trouble with the spray due to the abnormal shape of their nose, he said.

Why it’s going up

Saitz, chair of the department chair of community health sciences at BU, said the price of auto-injectors is going up because of packaging and branding.

“The medication itself has been around for decades,” he said. “The actual naloxone medication should be dirt cheap.”

In response to Evzio’s higher pricing, Saitz said, there is no need for the auto-injector to be expensive and that life-saving medication like this should be provided cheaply.

“When you don’t have it when you need it, then people die,” he said. “This is the kind of thing where you don’t want a co-payment at all.”

Dr. Katherine Dallow, vice president of clinical programs at Blue Cross Blue Shield Massachusetts, said the rising prices of pharmaceuticals is a challenge insurance companies face every day. She attributed higher prices to costs associated with research and development.

BCBS requires no co-payment or prescriptions on two naloxone products, including Narcan’s nasal spray and injection. It does not cover Evzio’s auto-injection system.

When deciding whether to cover drugs with high prices, she said, insurers consider if the medication offers a greater benefit compared to similar medicines that are covered and inexpensive.

“We already cover a nasal spray, and medically there’s no reason why we wouldn’t use the nasal spray as opposed to an injection,” Dallow said.

She said there are no appreciable differences between the Narcan products and Evzio auto-injectors; otherwise, she said, BCBS would have decided to cover the costs.

“It’s not a medication that we necessarily want to encourage people to take,” given the higher cost, Dallow said.

Importance of keeping costs low

Naloxone is critical from a public health standpoint. Last year, the Department of Public Health reported 1,617 confirmed opioid-related overdose deaths.

Moreover, someone who appears to have overdosed and is given naloxone by mistake will not suffer any harmful consequences.

Saitz said higher co-payments for naloxone products could deter people from gaining access to a drug that should be readily available.

“The more barriers that are in place, the less likely it’s going to be around when somebody needs it,” he said.

However, as long as inexpensive, effective medication remains available, Saitz said, he does not object to rising prices.

Dallow, who has been working in the medical field for more than 15 years, said she hopes to see more transparency from pharmaceutical companies to understand where their higher prices come from.

Accessibility

Hampshire HOPE is a Northampton organization that partners with medical centers and police departments to bring awareness to the opioid epidemic. Funded by the Massachusetts Department of Public Health, HOPE provides naloxone free to those who need it.

Cherry Sullivan, a coordinator at HOPE, says her coalition focuses on providing the nasal naloxone spray.

“We want naloxone to be affordable for everyone in the community,” Sullivan said.

She said that even with the rising price of the auto-injector, there are many organizations like hers where people can get other naloxone products for free.

Additionally, most people in Massachusetts are insured, so they would have access to at least some forms. According to the latest U.S. Census Bureau data, Massachusetts has one of the highest rates of insured residents.

“We don’t want cost to be a barrier,” Sullivan said.

But the pricing policy was the focus of a recent congressional report that criticized Kaleo, the maker of Evzio, for the dramatic price hikes and the cost to taxpayers.

“We believe patients and physicians should have meaningful choices,” the company said in a statement. “There is no doubt, the complexity of our health care system has had unintended negative implications for everyone involved, but most importantly, for patients. To this end, we explored viable paths within the current healthcare system to make Evzio available to patients in a responsible, meaningful and affordable way.”

The company said it donates treatment kits and has never made a profit.

A new generic form of naloxone may also affect the price. After finally receiving approval from the FDA in April, Teva Pharmaceuticals should start selling its naloxone nasal spray over the counter soon. This is expected to be significantly cheaper than brand names like Narcan and Evzio.

Dallow said she wishes naloxone products were more affordable but also waits for a day when people aren’t always relying on these medications.

“We’re really looking forward to the day that access to medication doesn’t need to be so readily available because then work in preventing opioid addiction has been working,” she said. “But we are a long way from that.”

This article was originally published in the Worcester Telegram.