Drug to reverse OD, but at a cost
Study finds naloxone price out of reach for uninsured, despite access improvements
The cost of buying the opioid antidote naloxone is out of reach for many uninsured Americans, a hurdle that may keep the treatment from saving more people who overdose on opioids, according to a new RAND Corp. study.
While laws making it easier to prescribe and obtain naloxone, also known by the brand name Narcan, have increased the use of the medication, the out-of-pocket cost of the drug for the uninsured has risen sharply — even while falling for many who are insured, according to the findings published in the latest edition of the journal JAMA Health Forum.
The study found that the average out-ofpocket cost per naloxone prescription among those who have health insurance declined by 26 percent from 2014 to 2018, while out-of-pocket costs increased by more than 500 percent for people who are uninsured. About 20 percent of adults with an opioid-use disorder are uninsured, as are nearly one-third of those who die of an opioid overdose.
“The price of naloxone is almost certainly an impediment to more widespread adoption among the uninsured,” said Evan Peet, the study’s lead author and an economist at RAND, a nonprofit research organization. “Policymakers who want to further expand access to naloxone — particularly among the uninsured and vulnerable — need to pay greater attention to the out-of-pocket costs.”
Among the strategies adopted by federal and state policymakers to battle the opioid crisis is increasing the distribution of naloxone, which can reverse the effects of an opioid overdose if given to a person promptly.
While many states have adopted laws to make it easier to prescribe and dispense naloxone, less attention has focused on potential financial barriers to naloxone
access.
In New York, Health Commissioner Mary T. Basset recently announced a statewide standing order for naloxone, which enables New Yorkers to access the drug at any pharmacy without a prescription.
Uninsured New Yorkers and those without prescription coverage can find naloxone at no cost through New York’s network of registered opioid overdose prevention programs, a state Department of Health spokesperson said.
And insured individuals can get copayments up to $40 reimbursed through the state Health Department’s Naloxone Copayment Assistance Program, the spokesperson said.
Researchers from RAND and the University of Southern California examined more than 700,000 prescription records from 2010 to 2018 for both generic and name-brand naloxone to examine trends in out-ofpocket costs. The sample included information from more than 70 percent of the nation’s retail pharmacies.
Prescriptions filled for naloxone increased sharply over the study period. While the sample saw 11,432 naloxone prescriptions filled during 2010, the number grew to 386,249 in 2018.
Despite legal changes that make it easier to buy naloxone and pharmaceutical innovations that have enabled lay persons to administer naloxone, the increase in naloxone prescriptions was not equally distributed. While naloxone distribution rose substantially starting in 2017 among the insured, naloxone access among the uninsured did not experience similar gains.
Researchers say cost is likely one important factor in the lower use among the uninsured. As use of naloxone increased, the out-of-pocket costs fell for most people with health insurance, while it increased for those who are uninsured.
In 2014, the average out-ofpocket cost per naloxone prescription among insured people
was $27, while it was $35 for those who were uninsured.
By 2018, the average out-ofpocket per naloxone prescription for the insured dropped to $18, but for the uninsured it had ballooned to $250.
“Federal and state policies have regularly targeted legal barriers to accessing naloxone, with less emphasis on financial barriers,” Peet said. “These results provide evidence that while naloxone access has improved, out-of-pocket costs remain a significant impediment, particularly for the uninsured.”
In order to increase the use of naloxone and prevent opioid overdose deaths, policymakers could consider implementing price subsidies for naloxone purchases, regulating copays for the insured and issuing coupons targeting the uninsured, researchers said.