The rising cost of naloxone—a 40-year-old drug that can reverse an opioid overdose—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.
Baltimore Health Commissioner Dr. Leana Wen told Modern Healthcare last week that the cost of naloxone has prevented her department from blanketing the city with the drug as she had hoped.
Baltimore now pays around $40 for a single dose of naloxone, double what the city was paying in July last year.
The Centers for Diseases Control and Prevention recently recommended that providers begin prescribing naloxone in tandem with opioid pain medications.
State governments, meanwhile, have been pushing for broader use of the drug for several years. Most states have established protections from liability related to administering naloxone and, like Baltimore, distribute it do first responders with standing orders.
But the prices “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.
Drugmakers, meanwhile, have priced naloxone products based on the expectation that they will be added to formularies of health insurance companies and pharmacy benefit managers, which have the leverage to negotiate discounts, according to Daniel Raymond, policy director at the Harm Reduction Coalition.
Cities and states, on the other hand, buy directly from manufacturers.
In recent years, states have received federal block grants that help them buy naloxone. Last week, HHS announced it would send $53 million to 44 states, four tribes and the District of Columbia to fund initiatives addressing opioid abuse.
That includes up to $11 million to 12 states for training and naloxone purchases to help first responders prevent opioid-related overdose deaths.
But the federal government has taken a more aggressive approach to making sure the population is vaccinated against diseases deemed a threat to public health.
The CDC buys vaccines at a discount and distributes them to state and local health departments, which provide them at no charge to eligible patients at federally qualified health clinics.
Erin Taylor, an associate policy researcher at RAND Corp., wondered if it's time to consider a regulatory mechanism to guarantee access to naloxone.