Naloxone Access Expands and Price Increases

by pharmacy on September 2, 2015

naloxone factsNaloxone, a drug used to reverse the effects of opioids and other narcotic medicines, is becoming more accessible. The medication, especially in the hands of first responders, seems to be doing a good job at providing treatment before an opioid overdose occurs. But, the success of the drug is certainly coming with a price – and one that doesn’t seem like it will be coming down anytime soon.

Kaleo Inc. launched the 1 mg/mL naloxone hydrochloride auto injector Evzio in July 2014. At launch, the company priced each carton at roughly four times the price of a box of 1 mg/mL 2-mL syringes, according to FDA analyst Matthew Rosenberg.

The new product is a drug-device combination pack that uses an electronic audio system to provide step-by-step instructions on how to inject the drug into subcutaneous or muscle tissue. Each carton contains two 0.4 mg/mL injection auto injectors, and a reusable training device.

Nearly two months after the auto injector hit the market, the price for the 10-pack of syringes, manufactured by Amphastar Pharmaceuticals, went up by about 60%, according to Rosenberg.

Each 2-mL syringe designed to fit onto an atomizer for intranasal administration costs around $50. The high price tag means many community-based programs aren’t able to fulfill their mission,

Eliza Wheeler, who works with the Drug Overdose Prevention and Education Project in San Francisco, says the program has had to switch to a less expensive product. With the exception of a pilot project at the local jails, she says they use 1-mL vials for intramuscular injection.

Why? A 10-pack carton of the 1-mL, 0.4 mg/mL vials manufactured by either Mylan Institutional LLC or Hospira Inc. is about 50% less than the carton of 10 2-mL syringes.

Wheeler says her program hears all the time from other programs that are either unable to start, have to scale back their efforts, have to prioritize who they’re giving the medicine to, or have to completely close up shop because of the expense of the medicine.

Some naloxone is federally funded – and that’s for veterans receiving services through the Department of Veterans Affairs. There, Pharmacy Benefits Management (PBM) Services absorbs the cost of medication dispensed to patients.

The medication is dispensed as part of the Opioid Overdose Education and Naloxone Distribution (OEND) initiative. VA professionals educate patents on how to prevent, recognize, and respond to an overdose. They distribute the Naloxone kits, and teach recipients how to assemble everything to administer the medication. The program began in Cleveland, but went national in May 2014.

From October 2014 through May 2015, the VA gave more than 5,400 kits to veterans, and at least 79 of them have been used to reverse an overdose. PBM services could potentially provide up to 28,000 free kits to VA facilities, leaving veterans responsible for their standard $9 copay.

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