Naloxone’s steep price hinders battle against opioid epidemic

Cost is one of the biggest hurdles in getting naloxone, the opioid overdose-reversing drug, into more hands.

Evzio, a hand-held auto injector, has risen from less than $600 in 2014 to more than $4,000 for a two-pack now, according to members of Congress who say it’s time the government do something to tamp down on the price.

NARCAN, a form of the drug delivered as a nasal spray that’s considered easiest for regular people to carry and administer in emergencies, costs $125 for a two-dose carton — though governments and public-interest nonprofits can get it for $75.

Some officials say that for a country dealing with the opioid epidemic, those prices are too high — and they’re rising.

The price of a 1-milligram vial of injectable or intranasal naloxone from Amphastar nearly doubled from 2009 to 2016, while a 10-dose amount from Hospira increased from $62 in 2012 to $142 over a four-year period, according to a New England Journal of Medicine article that examined average wholesale prices in December 2016.

Dr. Ravi Gupta, a resident doctor in Baltimore who co-authored the 2016 report, says it appears prices have stabilized — but they’re still high enough that it’s a barrier to getting them into the hands of police, ambulance workers and family members who are likely to first come across someone suffering an opioid overdose.

Baltimore City Health Commissioner Leana S. Wen says cost is the No. 1 impediment to its efforts to put naloxone spray into as many hands as possible, since a mix of government and philanthropic funding only stretches so far.

“It doesn’t make sense that we have an antidote available and we’re not able to issue that to everyone who needs it,” she said. “Naloxone is effective. We need this at a cheaper and more affordable price.”

The price increases have some lawmakers on Capitol Hill wondering if manufacturers are gouging at a time of national crisis.

“Frankly, I think the drug companies are taking advantage of the pain and suffering and the loss of life in this situation,” said Sen. Debbie Stabenow, Michigan Democrat who sits on the Senate Heath Committee.

Joshua M. Sharfstein, a professor at the Johns Hopkins Bloomberg School of Public Health, said the most likely reason for the price hikes is that “fancy” products like the auto-injector aren’t made by anyone else, “so they’re charging what they can,” while generic injectable drugs are rising across the board, due to the limited number of companies supplying the products.

Naloxone isn’t a panacea for the opioids crisis — it only keeps people alive so they have a chance at recovery. But it’s considered a critical tool in the government’s arsenal, and Surgeon General Jerome Adams recently advised more everyday Americans to hold naloxone.

Assistant Health and Human Services Secretary Brett P. Giroir says the Food and Drug Administration is hoping the emergence of generic competitors and making naloxone available over the counter could drive down prices.

HHS also says the government already doles out grants that states can use to buy doses. And federal officials praised Adapt Pharma and Kaleo Pharma, which makes Evzio, for donating 30,000 doses to U.S. communities last month.

Naloxone manufacturers say they do take steps to bring down costs.

Adapt spokesman Thomas Duddy said Narcan has “near-universal” coverage under health plans and copays are affordable, with 75 percent of customers paying $10 or less and more than a third paying zero out of pocket.

Similarly, Kaleo said despite its $4,100 list price for Evzio, Americans who hold insurance and prescription can get it at no cost to them through a direct-delivery service, while people without insurance can also get it for free if their household earns less than $100,000.

“The increased price allows us to absorb the costs and step in to provide Evzio free of charge to patients blocked by their commercial insurance company or patients facing financial hardship,” the company said.

Kaleo said it also slashed its price for government and tribal buyers, to $180 per auto-injector ($360 for a two-pack).

Pfizer, meanwhile, said it hasn’t increased the price of its single-dose naloxone since acquiring Hospira in 2015, it is donating 1 million doses over a four-year period and it discounts its naloxone for 40 organizations.

Amphastar Pharmaceuticals couldn’t be reached for comment.

Experts say the underlying prices are still a concern, since private insurers and governments that pick up the tab will pass along the costs, even if consumers don’t see them upfront.

“It’s essential to pay attention to both cost of consumer and the cost overall. The overall cost is paid for by consumers individuals indirectly, through higher premiums or higher taxes,” Dr. Sharfstein said.