By Christine Stapleton and and and Joe Capozzi
The Palm Beach Post
PALM BEACH, Fla. — The price of naloxone — the lifesaving heroin-overdose antidote — has skyrocketed, with one formulation rising more than 500 percent in two years, an article in the prestigious New England Journal of Medicine reported.
Although Narcan first hit the market in 1971, demand has skyrocketed as the nationwide heroin epidemic worsens. And with more potent opioids on the street, the largest consumers of the drug, fire-rescue workers, are finding they need multiple doses to revive overdose victims.
In 2015, Palm Beach County Fire Rescue spent $55,000 on naloxone, the generic version of the drug. In the first nine months of 2016, the department spent $183,000. That does not include spending in cities with their own police and fire-rescue departments, such as Delray Beach.
On Tuesday, a private Lake Worth drug treatment center donated $25,000 to Palm Beach County Fire Rescue to buy Narcan. The donation by The Treatment Center of the Palm Beaches will affect about 700 patients, or the rough equivalent of three to four months of emergency overdose calls, said Rich Ellis, fire rescue’s emergency medical services chief.
So far this year, county fire-rescue crews have responded to 2,383 calls where naloxone was used. By the end of December, Ellis said, the number could nearly double the roughly 1,300 calls in 2015. Fire rescue’s budget for naloxone is $289,000.
“This societal problem knows no boundaries in Palm Beach County,” Fire Rescue Chief Jeff Collins said. “It goes from north to south, from coast to coast. We run calls all day long on heroin overdoses.”
Next year, crews will start using a nasal spray version of the drug, which also can be applied through an auto-injector designed for people without medical training.
“That will be more efficient,’’ Collins said. “Currently, when we administer Narcan, it comes by the box and when you break it open for one patient, they may need half the actual dosage and you have to throw the other half out.”
The patented single-dose auto-injector sold by Evzio, which provides real-time, audible instructions on how to use the device, has seen the biggest spike in cost, the New England Journal of Medicine article said. In 2014, a two-pack of single-use prefilled auto-injectors cost $690, according to the article. The current price is $4,500.
Evzio is made by kale’o, a Richmond, Va., pharmaceutical company. In a statement, the company pointed out that it has programs and a hotline, 877-438-9463, to provide the product for free, whether the patient is covered by insurance or not. The company said it also has donated more than 150,000 auto-injectors to more than 250 agencies in 34 states.
“We believe the most important cost for Evzio is the out-of-pocket cost to patients and their family and friends, and we have taken appropriate actions to ensure those who most need our innovative and potentially lifesaving product are able to access it,” the company said.
The average price of the nasal spray, two-pack is $150, unchanged since it was approved in 2015. This formulation is available at CVS pharmacies in Florida.
The average price of the most widely used injectible, a 0.4 mg vial, has risen 129 percent since 2012, from $62.29 to $142.49.
The authors of the article, published Dec. 8, liken the increase to price hikes imposed by Mylan, the manufacturer of the EpiPen.
“The naloxone situation has not garnered the type of attention or outrage inspired by that case, perhaps in part because of the stigma associated with opioid use,” the article said.
The authors suggest governments could buy in bulk, “which would create stable demand that might motivate additional companies to begin manufacturing this medication.” This strategy has been used for vaccine manufacturing.
Another option to control costs: Invoking federal law to contract with manufacturers on behalf of the federal government to produce less costly versions in exchange for reasonable royalties, an approach considered for procuring an antibiotic during the anthrax threat in 2001.
Officials also could allow imports of generics from international manufacturers that meet U.S. production standards.
To promote transparency in drug pricing, lawmakers could follow initiatives like those taken in Vermont, where new legislation requires companies to justify price increases.
In Washington, recently proposed legislation would require makers of certain drugs to report to the Department of Health and Human Services when the price of a drug increases at least 10 percent in a 12-month period. The bill has bipartisan support.
While Palm Beach County Fire-Rescue officials are not actively seeking donations, they hope The Treatment Center’s gesture will spur other private companies in the addiction-treatment industry to donate money for naloxone.
“The donation by The Treatment Center is the tip of the spear,’’ said Palm Beach County Fire Rescue Capt. Houston Park, who has organized a countywide Heroin Task Force.
“They stepped up to the plate on a community effort. With depletion of Narcan as a quickly as we are going through it, any time we get money like this, it’s a tremendous support.”
Copyright 2016 The Palm Beach Post