When the American Medical Association annual meeting convenes in Chicago on Sunday, the powerful physicians’ lobby could push for government intervention to lower the price of the heroin overdose-reversing drug naloxone.
A resolution written by a Michigan doctor and three medical students notes the skyrocketing cost of the drug — a two-pack of auto-injecting syringes went from $690 in 2014 to more than $4,000 this year, while other forms of the drug have doubled in price — and calls on legislators and regulators to increase public access to affordable naloxone.
“The population I serve often has difficulty affording medications for chronic illnesses that they require daily, so the idea that they would be able to purchase an increasingly costly overdose reversal medication would certainly be out of the question for them,” said Dr. Gunjan Malhotra, who works in Detroit.
But in a sign of the labyrinthine and confusing world of drug pricing, some Chicago area groups that distribute the antidote say they get it free from the manufacturers or at very little cost. Others say they pay dearly.
“It really seems like one of the most important tools (to fight overdoses) is getting naloxone into the hands of as many people as possible; raising prices will not help us,” said Gabriela Zapata-Alma of Thresholds, a mental health agency that pays $250 for a three-dose kit of naloxone that comes in the form of a nasal spray.
A spokesman for Adapt Pharma, which makes the Narcan-brand nasal spray, said the company offers two-packs to nonprofit groups for $75.
Naloxone reverses the effects of a heroin or narcotic painkiller overdose, and as America’s opioid epidemic has exploded over the past 20 years, it has become a frontline defense for people with little or no medical training.
Police officers across the state have stopped dozens of overdoses after they started carrying the kits, and naloxone is now commonplace in schools, too. Organizations like the Chicago Recovery Alliance put the drug in the hands of heroin users and their friends and family.
Dan Bigg, head of the alliance, said the group has given out around 300,000 doses over the past 21 years, and that he has received more than 11,000 reports of overdose reversals in that time.
The alliance distributes the cheapest form of naloxone — a vial of the drug and a syringe — which Bigg said he gets at a reduced cost from the manufacturer (at the company’s request, he wouldn’t reveal the price).
“Anyone can come to us and get the low-tech, cheapest option,” he said. “I’ve never heard of anyone being too squeamish to use the needle in an emergency.”
Chelsea Laliberte, whose Live4Lali nonprofit does similar naloxone distribution in the suburbs and Downstate, said she has been able to get the drug for free via drug company grants. But it is expanding its efforts this year, and so has begun to pay for naloxone.
She, too, wouldn’t discuss the exact price, but said it was under $20 per dose.
“We’re only willing to pay for what is the most viable, sustainable option, which is a syringe and vials,” she said. “We don’t pay $4,400 a kit for (auto-injectors). I would never do that with anyone’s donation dollars.”
The auto-injector, sold under the brand name Evzio, is made by the drug company Kaleo. The device contains a recording that guides users through the process with voice commands. In a study performed by Kaleo employees, 90 percent of people were able to use the Evzio successfully without training, while no one was able to administer the nasal spray correctly.
The company has donated thousands of units to various groups; one recipient is the Lake County Health Department, which distributes its haul to local police departments. Despite the high list price, which does not take into account negotiated discounts and rebates, a Kaleo spokesman said patients with commercial insurance and uninsured people making less than $100,000 pay nothing for the device.
People paying cash can get it for $360 by calling a hotline, he said.
Dr. Steven Aks of the Cook County Health and Hospitals System said his agency distributes naloxone to drug users through the emergency room and health clinics. Though rising prices have not affected the department’s ability to offer the antidote, he said it could be a different story outside the Chicago area.
“If they’re in a rural area … they’re not going to have the same access,” he said. “If they go to a pharmacy to get a prescription filled, that’s when they’re going to find the sticker shock.”
Garth Reynolds, executive director of the Illinois Pharmacists Association, said he hasn’t heard any accounts of rural pharmacies failing to stock the drug for cost reasons. State law requires insurance programs, including Medicaid, to pay for naloxone, he said.
“Most pharmacists understand the heightened awareness we have on this issue and the need for naloxone in our communities,” he said.
Those without insurance or a prescription can still buy naloxone at a drugstore. Walgreens said the cash price is $20 for a generic, single-dose vial and syringe, or $40 for a generic nasal spray; CVS said the uninsured pay $45 for a two-dose injectable version and $110 for the Narcan-brand nasal spray.
Researchers who examined the rising price of naloxone wrote in the New England Journal of Medicine last year that the cost might have contributed to the relatively slow adoption of the drug.
Between 2009 and 2015, they wrote, naloxone prescriptions increased from 2.8 million to just 3.2 million, even as opioid overdose deaths rose from 20,000 to 33,000.
They called for the federal government to take steps that are reflected in the AMA resolution, including negotiating cheaper prices with drug companies and making naloxone an over-the-counter drug, which would cut prices by attracting new manufacturers.
The AMA will hold a committee vote on the resolution Sunday, and if it passes, delegates will debate and vote on it later in the week. Though the measure holds no force of law, Malhotra and her colleagues said they hoped it would be a strong advocacy statement.
“This tells legislators and citizens across our country that America’s physicians think we can do more to fight the opioid epidemic,” said Eric Walton, a student at the Wayne State University School of Medicine. “Naloxone affordability is a commonsense step toward ending opioid-related deaths.”
jkeilman@tribpub.com
Twitter @JohnKeilman
