Why is Big Pharma Raising Prices on Naloxone?

By Paul Gaita 12/19/17

Price hikes have put naloxone out of financial reach for thousands of individuals with substance dependency issues as well as first responders.

naloxone sitting on a steel counter

A new feature from The Nation casts light on a potentially dangerous scenario for both the public at large and the health care community: as national statistics for opioid overdose and deaths continue to mount, many of the pharmaceutical companies that manufacture naloxone, the opioid overdose reversal drug, have increased the price for their versions of the drug.

The cost hikes have put the drug out of financial reach for thousands of individuals with substance dependency issues and their families, as well as first responders, state and local governments and community outreach participants, all of whom have attempted to stockpile the drug for substance dependants. Representatives from the pharmaceutical companies have defended—or deflected—the price hikes by pointing to numerous donations of their naloxone product and discounts to consumers.

Naloxone, which is manufactured as an injectable drug or a nasal spray, is an opioid antagonist that binds to opioid receptors in the user's system and can restore normal breathing when an opioid overdose causes the user's respiratory and central nervous system to fail.

As the Nation notes, the most popular form of naloxone, the Narcan nasal spray made and manufactured by Adapt Pharma, has remained at the same price level of $150 since it entered the market in 2015. 

But other pharmaceutical companies have responded to increased need for their naloxone drugs by raising their prices, often to steep rates: the feature cites Amphastar, which nearly doubled the price of its drug from $20.34 to $39.60, while a two-dose package of kaléo's two-dose auto-injector device, Evzio, rose from $690 in 2014 to $4,500 in 2016—an increase of 500%, according to the Nation. As a result, sales of naloxone products have also risen from $21.3 million in 2011 to $274.1 million in 2016.

Pharmaceutical companies have defended these increases by noting philanthropic gestures and cost-reduction policies for consumers; in the Nation piece, kaléo noted that Evzio has no co-pay for individuals with commercial insurance, and has donated more than a quarter-million kits to public health departments and advocacy groups.

Others, like Adapt, have cited their product's relative ease of use and individuality—Narcan is currently the only approved nasal product on the market—and also notes discounts provided to government and non-profit agencies, such as a discounted rate of $75 per kit to a Philadelphia-based dependency education organization.

Despite these gestures, the Nation points to one core fact about naloxone prices: the companies can set a price for their product because there are few, if any, alternatives for consumers. In some cases, manufacturers have even asked the Food and Drug Administration (FDA) to set specifications that could block production of new forms, including generics.

The Nation points to a 2016 petition by Adapt that requested the agency to determine a baseline dosage of naloxone in products, and to refrain from approving any future products that did not meet the standards. The FDA rejected the majority of the petition.

Major cities have been able to contend with price hikes through a combination of manufacturer discounts, government programs to subsidize co-payments, such as the one announced by New York Governor Andrew Cuomo in August 2017, and outside support such as the $50,000 grant awarded by the Tuttleman Family Foundation to the city of Philadelphia's police department. But other organizations and entities may face the difficult decision of reducing the number of individuals they can help with naloxone.

"We think we're going to have over 900 overdose-related deaths in Philadelphia County. Three times the homicide rate, so it's huge," said Jose Benitez, executive director of the harm reduction group Prevention Point Philadelphia. "Clearly we're not getting enough Narcan out to those who are at highest risk."

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, Amazon.com and The Los Angeles Beat, among many other publications and websites.