In the latest attempt to combat prescription drug abuse, two US senators want several drug makers to explain their pricing for naloxone, a decades-old drug that is widely used to reverse the effect of opioid and heroin overdoses.
The move comes amid ongoing reports that the cost of the treatment continues to rise, despite bitter complaints from public officials. At the same time, public health officials cite a growing number of overdose deaths — more than 27,000 were recorded in the US in 2014.
In identical letters to five drug makers, Susan Collins, a Maine Republican, and Claire McCaskill, a Democrat from Missouri who chairs the Senate Special Committee on Aging, wrote that they are concerned that rising prices “may be limited access for emergency responders and public health departments.”
Prescription drug pricing is a highly contentious issue, and McCaskill and Collins held closely watched hearings last year to examine huge price hikes taken by Valeant Pharmaceuticals and Turing Pharmaceuticals, which was run by Martin Shkreli.
But naloxone has received special attention, because the medicine is used to reverse the effects of opioids on the brain and can limit or stop a heroin or prescription opioid overdose. “It becomes critical in the field for a cop, a paramedic, or EMT worker,” said Dr. Lewis Nelson, an emergency medicine specialist at the New York University Langone Medical Center. “You could watch someone die without it.”
The most common formulation used by police departments, hospitals, and addiction advocacy organizations is made by Amphastar Pharmaceuticals (AMPH), which created a ruckus by raising the list price of 10 pre-filled, 2-milliliter syringes from $120 to $330 in October 2014, according to Truven Health Analytics. The list price for 10 fixed-needle syringes also rose from $169.50 to $330.
Such price hikes sparked anger among state agencies and, shortly afterward, prompted Senator Bernie Sanders and Representative Elijah Cummings, a Maryland Democrat, to pressure Amphastar for pricing information. The company responded to the pressure, in part, by striking deals with some states to sell its drug at a reduced rate.
Two months ago, for instance, Amphastar reached such an agreement with the Connecticut attorney general and, in January, renewed a similar yearlong agreement with the New York state attorney general. We asked Amphastar for comment and will pass along any reply.
“One concern is that money for naloxone is coming out of the same pot as money for treatment and prevention,” Alison Knopf, editor of Alcoholism & Drug Abuse Weekly. “The costlier it is, the less money for treatment and prevention.”
Meanwhile, last February, Kaleo Pharma raised the list price for two single-dose injectors to $3,750, from $750, a price that was set last November, after previously costing $575, according to Truven.
Collins and McCaskill also wrote the other companies that market versions of the drug, including Mylan Laboratories, Kaleo, Adapt Pharmaceuticals, and Pfizer (PFE), whose Hospira unit markets a form of the drug. They asked what the companies are doing to ensure access to their treatments. We asked each company for their reaction to the letter and will update you accordingly.
[UPDATE: An Adapt spokesman wrote us that the price of its Narcan nasal spray version has remained steady at $125 for a carton of two doses, and a 40 percent discount is available to non-profits, community-based organizations, and first responders to buy two doses for $75.
And a Kaleo spokesman sent us a note saying the company has a program that provides “little to no out-of-pocket costs” to patients and caregivers with commercial insurance. We asked about actual costs, and will provide any reply. The company, he added, has also donated more than 150,000 doses of Evzio.]