Lifesaving Opioid Overdose Antidote Drug, Naloxone, Continues Upward Pricing Spiral

Oregon hospitals join ranks contributing to naloxone price hikes while lawmakers scrutinize drug company no-holds-barred pricing strategies. Nearly 60 percent of Oregon’s hospitals have recently increased prices of naloxone – an opioid overdose antidote drug – by more than 10 percent. Five of these hospitals hiked the price of the drug ranging from 100 to 300 percent in 2014 compared to the previous year.

A lifesaving opioid overdose antidote used effectively for substance abuse - Naloxone Hydrochloride - has skyrocketed in the past couple years, worrying state health advocates across the U.S. with Oregon among them.

Hospital Pricing Specialists analyzed the cost of a 1 mg naloxone injection at hospitals finding extreme price hikes (the most striking price increases ranged between 100 and 1,000 percent or more) across the U.S. between 2013 and 2014. See the report here.

In Oregon, Kaiser Sunnyside Medical Center quadrupled the price of the drug, raising its rate for a 1 mg naloxone injection from $22.80 to $94.75. Starting at a higher price point, McKenzie Willamette Medical Center - a for-profit hospital – more than tripled naloxone’s price (a 204 percent increase from $56.09 to $170.50.).

Naloxone treatment reverses affects of an opioid (drug) overdose, helps users weather the storm while waiting to get into a treatment program, and aids in relapse survival.

A report last July 2015 by Oregon Health & Science University and the Center for Evidence-based Policy asserted that opioid overdose is a leading cause of preventable death in this country. In 2013, there were more than 24,000 overdose deaths from prescription and illicit opioid drugs in the U.S. (a 300 percent increase since 1999.). More recent reports estimate fatal drug overdose as high as 47,000 annually.

Lawmakers across the U.S. have urged federal action to increase availability of naloxone to the public. By September 2015, CVS had expanded sales of the overdose reversal drug naloxone without a prescription to 14 states. According to a recent report by The Network for Public Health, in June 2016, all but three states (KS, MT, WY) had passed legislation to improve layperson naloxone access.

Some onlookers have pointed fingers to pharmaceutical company’s no-holds-barred pricing strategies in response to increased market demand as the main culprits for price escalation. NPR reported in 2015 that Baltimore and other cities are choosing to administer naloxone with an intranasal spray application instead of injection. At the time, Amphastar Pharmaceuticals was the only manufacturer of naloxone’s intranasal dosage. With no competition and high demand, the company doubled its price in the Baltimore area (from $20 to $40 per dose) citing as its reasons: increased manufacturing costs (including raw materials), energy, and labor.

Fast-forward to May of 2016, Politico reported that the U.S. House of Representatives passed 18 bills designed to increase naloxone access. At this time several lawmakers – including Democratic presidential candidate Sen. Bernie Sanders, Maryland Rep. Elijah Cummings, and Rep. Patrick Meehan (R-Pa.) – had begun scrutinizing naloxone price hikes.

With Amphastar again under the microscope, the drug company claimed increased pricing was due to third party repackaging of its popular nasal spray (citing an online store selling naloxone kits for more than $130.)

In response to questions from The Lund Report about price hikes at Providence hospitals, its communications director, Gary Walker, attributed the increased costs to greater use of the drug, fewer generic products, and the freedom by pharmaceutical companies to price the drug however they like.

“In our experience, they [pharmaceutical companies] have raised the rates particularly for those products that come in single dose, ready to use devices,” he said. “One of the challenges health systems face is working with pharmaceutical manufacturers to persuade them to develop pricing policies that are sustainable for our patients.”

The Lund Report reached out to Jim Gardner, Oregon counsel for the Pharmaceutical Research and Manufacturers of America, who declined to comment, saying this matter was not within his purview. When contacted, PhRMA’s communications team did not respond by press time.

In Oregon, the majority of hospitals increased the price of naloxone, and five of these hospitals hiked the cost ranging from 2-4 times between 2013 and 2014. From highest to lowest increase, these Oregon hospitals have increased rates most dramatically:

  • Kaiser Sunnyside Medical Center, $22.8-$94.75 (316%)
  • McKenzie Willamette Medical Center, $56.09-$170.50 (204%)
  • Providence Hood River Memorial Hospital, $52.25-$151.96 (191%)
  • Providence St Vincent Medical Center, $69.68- $190.90 (174%)
  • Providence Portland Medical Center, $69.68- $190.90 (174%)
  • Providence Milwaukie Hospital, $69.68- $190.90 (174%)
  • Providence Seaside Hospital, $91.88-$218.84 (138%)
  • Mid-Columbia Medical Center, $118.94-$243.94 (105%)

Across Oregon, these hospitals increased prices from 13 to 62 percent (listed highest to lowest in this range):

  • Santiam Memorial, $20.29-$32.78 (62%)
  • Wallowa Memorial Hospital, $62-$100 (61%)
  • Mountain View Hospital, $34.86-$49.30 (41%)
  • Rogue Regional Medical, $99.36-$134.14 (35%)
  • Sky Lakes Medical, $54.90-$72.79 (33%)
  • Salem Hospital, $25.79-$34.06 (32%)
  • Grande Ronde Hospital, $36.90-$45.13 (22%)
  • Mercy Medical Center $64.33-$75.11 (17%)
  • Asante Three Rivers Medical Center, $100.56-$115.77 (15%)
  • Providence Medford Medical Center, $133.31-$151.13 (13%) 
  • Pioneer Memorial Hospital, $43.55-$49.30 (13%)

Naloxone stops an overdose by blocking opiate receptors in the brain, and comes in several forms: injectable, a nasal spray, and an auto injector (a device that talks a person administering the drug through the process).

According to an interview reported in Street Roots with Marcus Watt, executive director of the Oregon Board of Pharmacy, “the more complex the device, the more expensive it gets.”

Mike Foley, communications manager for Kaiser Permanente, acknowledged naloxone’s recent price increase and suggested checking with the drug’s manufacturer for answers. “We now primarily use the nasal inhaled form of naloxone that is more effective and less expensive.”

Kathryn can be reached at [email protected].

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