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Skyrocketing Naloxone Prices Put Pressure On Local Agencies

Craig Zirpolo

Thanks to new laws lifting restrictions on the availability of naloxone, the overdose-intervention drug is now easier to find than ever before. But the drug’s skyrocketing price means certain public health agencies are having to hustle to keep it on the shelves.

According to the Food and Drug Administartion, two companies, Amphastar and Hospira (which was recently acquired by manufacturing giant Pfizer), produce the majority of naloxone in the United States. The drug has historically been available in two different dosages. The market for a smaller, .4 mg dosage (used for intramuscular injection) has been dominated by Hospira, and a larger 1 mg. dosage, also historically used for injection use, is dominated by Amphastar. In recent years, users have started attaching a spray atomizer to the larger 1 mg. syringe and additionally used it as an intranasal spray, although that use isn’t technically approved by the FDA. (Amphastar is currently working on a ready-made nasal spray as well.)

Amphastar increased its price for outpatient use of naloxone doses by 60 percent in 2014, citing increasing manufacturing costs. That same year, Hospira, the majority provider of a smaller-dosage option, increased its price about 50 percent.

Other reports indicate the cost of the drug has increased tenfold in last decade.

Drug companies have been riding high on naloxone’s popularity…For example, in the first quarter of 2016, Amphastar, one of the two big naloxone manufacturers, saw a four percent increase in revenue, which the company specifically attributes to increased sales of the drug. In its 2015 second quarter earnings report (the last before the company’s merger) Hospira’s net sales jumped 4.2 percent, due to strong sales of “specialty injectable pharmaceuticals.”

But while manufacturers are making money, local agencies are having a hard time keeping up with price increases.

Justin Phillips, founder and executive director of Overdose Lifeline, a nonprofit that distributes naloxone kits, says she’s seen prices for the nasal spray increase of $3.00 per dose in the past six months.

“It’s becoming extremely cost-prohibitive without large grant funds to distribute any of the kits,” she says.

Phillips describes the task she gave a new volunteer.

“[I told her] ‘we’ve got to find some ways to acquire this intramuscular administration for nothing or for very cheap.’”

The organization distributes the injection and nasal-spray form of the drug. Phillips says she’s seen both forms increase in price.

The organization works with manufacturers to negotiate prices, holds fundraisers and applies for competitive grants to help pay for the drug.

More companies have been entering the naloxone market, introducing new ways of administering the intervention drug. One company, kaléo, gained FDA approval in 2014 of a talking “auto-injector” dubbed Evzio, guides the user through the injection process. With insurance, the device costs $30.00, although its wholesale price sales into the hundreds.

Last year, the first FDA-approved nasal spray, Narcan, was made available by a company called Adapt Pharma.

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