As the number of drug-related deaths hits record levels, questions are mounting about the cost of addiction treatment and who should pay for it.
Last year, more than 47,000 people died from drug overdoses in the U.S., marking the first time the number of those deaths surpassed the number of those killed in motor-vehicle crashes. Over the past decade, the number of heroin users in the U.S. has exploded.
Described by officials as a “public health crisis,” efforts to better address the problem have focused on medication-assisted treatment, or MAT, which use the drugs methadone and buprenorphine in conjunction with patient counseling.
While insurers are required to cover addiction treatment as one of 10 essential health benefits under the Affordable Care Act, recent proposed rules looking to expand that coverage have been met with opposition by insurers, who have said that losing the right to select what therapies they cover would result in higher drug costs.
“It would disincentivize drug companies from lowering their prices and providing affordable access to medications,” said Clare Krusing, spokeswoman for America's Health Insurance Plans, the leading insurer trade association. "If they don't have to negotiate, and if they get broad mandated coverage of their medications, what will keep prices in check?”
Insurers and pharmacy benefits managers currently choose which MAT drugs they will cover. Express Scripts Holding Co., the nation's largest pharmacy benefit manager, includes both methadone and buprenorphine in its formulary, while rival CVS Health only covers methadone.
Other payers reportedly do not cover methadone, which costs $4,000 per year, and is less expensive than buprenorphine. The cost comes out to around $76 a week for a daily dose. Some say that's reasonable when compared to the estimated $193 billion in annual costs related to drug addiction, according to a 2012 analysis by the White House Office of National Drug Control Policy (PDF).
“The cost of the drug itself is fairly trivial,” said Martin Iguchi, adjunct senior behavioral scientist at the RAND Corp. “Considering that it's something people will receive seven days a week, it seems like a relative bargain; compared to almost anything else in medicine, it's a very low cost.”
But even at $76 a week, some are surprised the price of methadone isn't lower, considering it has been in use for more than 40 years. Methadone was developed in Nazi Germany in the 1930s. It was first used in New York City in the 1960s.
“I think this drug, like some others, has escaped efforts to push the price down because it's seen as very cost effective relative to the costs associated with heroin addiction,” said Arthur Caplan, director of the division of medical ethics at New York University Langone Medical Center.
Caplan said methadone manufacturers and companies that make older drugs should face hard questions regarding their price. “Given the addiction problem, obviously $10 a day for a huge number of addicts is a lot of money,” he said.
A major driver for that price increase has been a sharp rise in the use of opioid drugs, such as prescription painkillers, and more recently heroin, both of which accounted for 61% of overdose deaths in 2104, according to the Centers for Disease Control and Prevention.
The CDC estimates the rate of daily users at 2 per 1,000 people in 2013, compared to 1 per 1,000 in 2002. More than 2 million Americans are estimated to receive some form of MAT, but nearly 20 million are in need of the treatment.
According to the U.S. Food and Drug Administration, eight pharmaceutical companies produce methadone.
A spokesperson with Mallinckrodt Pharmaceuticals, which markets 10 of the 28 MAT products approved for sale in the U.S., said the company “is focused on ensuring our medicines are available to all those patients who may benefit from them, and we have a long history of serving the addiction-treatment marketplace.”
The Mallinckrodt spokesman further stated, “Specialty generic medication is one of the most competitive sectors in specialty pharmaceuticals, and modest pricing increases and decreases can often occur in line with marketplace dynamics or in response to competition.”