The rising cost of naloxone—a 40-year-old drug capable of reversing drug overdoses—is prompting questions about the wisdom of allowing market-forces to determine the price of a vital tool in the public health response to the nation's opioid crisis.
Some say the federal government should purchase the drug and distribute it to state and local health agencies at a more affordable price.
Earlier this week, Baltimore health commissioner Dr. Leana Wen told Modern Healthcare that the cost of naloxone has prevented her department, which is at the forefront of the campaign to widen use of naloxone, from blanketing the city as she had hoped.
Baltimore currently pays around $40 for a single dose of naloxone, compared to $20 a dose it was paying in July 2015. An analysis conducted by Truven Health Analytics found the price for the injectable version of naloxone rose from $0.92 a dose to more than $15 a dose over the last decade.
“The rising costs of naloxone and other opioid overdose antidotes are causing local health departments to conserve dosages and train fewer people on naloxone usage,” said Dr. LaMar Hasbrouck, executive director for the National Association for County and City Health Officials.
Expanded use of naloxone has been recommended by the Centers for Diseases Control and Prevention, which earlier this year recommended providers prescribe the drug alongside opioid pain medications.
Over the past decade, many states have passed laws aimed at expanding use of naloxone. Currently, 42 states and the District of Columbia have criminal liability protections in place for first responders and the general public who administer the drug. A total of 42 states also allow naloxone to be distributed to first responders through a standing order, like Baltimore.
Drugmakers have priced naloxone based on the expectation that they will be added to formularies of health insurance companies and pharmacy benefit managers, according to Daniel Raymond, policy director at the Harm Reduction Coalition. Such firms can negotiate prices because of the volume at which they purchase.
Towns and states on the other hand buy directly from the manufacturers, many of whom have less purchasing power than that of insurers and PBMs.
“It's important to approach this as somewhat of a bifurcated market,” Raymond said.
Some public health organizations are relying on donations to maintain their supplies.
Erin Taylor, an associate policy researcher at RAND Corp., wonders if the federal government should get involved.
The government uses a similar type of purchasing model when purchasing vaccines for children. The CDC gets a discounted rate from producers to distribute to state and local health departments who provide them at no charge for eligible patients at federally qualified health clinics.
Hasbrouck said a similar model to buy naloxone would be a great model to consider,” but added his agency has yet to develop a policy calling for such a move.
In recent years, states have received block grants to purchase naloxone. Just this week, HHS announced it was allocating $53 million in funding to 44 states, four tribes and the District of Columbia to improve access to treatment for opioid use disorders and reduce opioid related deaths. Part of the funding package includes up to $11 million to 12 states to support training on preventing opioid-related overdose deaths and to purchase naloxone for first responders.
Meantime, public health officials are pressuring drug makers to reveal the reasons for the skyrocketing costs.
For its part, drug firm Kaleo, maker of the naloxone auto-injection product Evzio, stated that its prices were “reflective of innovation, years of extensive research to ensure the device is easy to use and reliable and to ensure the broadest access to this potentially life-saving product,” according to the company Vice President Mark Herzog.
But while the mechanisms to deliver the drug have evolved, the medication itself, remains the same as it was when it was first approved in 1971.
“I don't understand at all why there is this marked increase in the drug,” said Dr. Georges Benjamin, executive director for the American Public Health Association. “Those innovations are interesting but not earth-shattering.”