Up, Up with Prices

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

If the past decade has taught us anything about pharmaceutical products, it’s that necessity is the mother of price gouging. Whenever a health crisis arises, pharmaceutical companies are quick to respond with an abundance of products at exorbitant prices. Such is the case with Kaléo, the manufacturer of an injectable form of naloxone – the lifesaving medication that can reverse opioid and heroin overdoses – Evzio.

The price Kaléo’s unique auto-injecting naloxone twin pack of Evzio has increased 552.17% from $690 in 2014, to $4,500 in 2017 (Baldrige, 2017). This vast increase is not the only one of its kind: all five pharmaceutical companies that produce naloxone products – Amphastar, Pfizer, Adapt, Kaléo, and Mylan – have increased the cost of their versions of the drug, prompting Senators Clair McCaskill (D-MO) and Susan Collins (R-ME) to pose the following question to those companies:

“At the same time this epidemic is killing tens of thousands of Americans a year, we’re seeing the price of naloxone go up by 1000% or more. Maybe there’s a great reason for the price increases, but given the heart-breaking gravity of this epidemic and the need for this drug, I think we have to demand some answers (Jacobs, 2016).”

Sen. Bill Cassidy, R-La., listens on Jan. 23 as Maine Sen. Susan Collins discusses her Affordable Care Act replacement plan.

Photo Source:J. Scott Applewhite/Associated Press

Naloxone, in and of itself, is neither expensive to manufacture, nor is it difficult to produce. Injectable versions of the drug that require hand-operated syringes cost between $20.40 and $39.60, respective to milligrams-per-milliliter and size of the vial; but even those costs have risen substantially over the past decade (Gupta, 2016).

Much like Mylan did with Epi-Pen, the epinephrine shot that counteracts allergic reactions, what Kaléo uses to justify its price increases has more to do with the delivery method, rather than the drug itself. Evzio is unique in that it utilizes both an auto-injector mechanism, and “intelligent voice guidance,” which Kaléo describes as “Simple, on-the-spot voice and visual guidance [that] helps caregivers take fast, confident action administering naloxone during an opioid emergency and reminds the user to call 911” (Kaléo, n.d.). While this product is unique in these features, certainly the cost of the auto-injector mechanism and an audio device that can be found in greeting cards do not justify a price of $2,250 per dose.

While furor over this price increase has yet to gather full steam, health departments in northern Kentucky and in Cincinnati, Ohio have avoided the sticker shock by abandoning Evzio, altogether, by switching from Kaléo’s product to Adapt Pharma’s Narcan nasal spray, which has a Wholesale Acquisition Cost (WAC) of $125 per carton for two doses (DeMio & Luthra, 2017). Both Ohio and Kentucky, along with nearby Indiana, have experienced some of the highest rates of opioid and heroin abuse in the U.S., making naloxone a relatively basic necessity for every branch of emergency services, as well as schools and businesses. Adapt’s currently available dose is 4mg is designed for use in emergency situations; the Food and Drug Administration (FDA) has recently approved a 2mg dose of Narcan, which is designed for use in opioid-dependent patients expected to be at risk for severe opioid withdrawal in situations where there is a low risk for accidental or intentional opioid exposure by household contacts (Barrett, 2017).

It is understandable that pharmaceutical companies need to make a profit in order to continue making new products, it is both unacceptable, and unconscionable for manufacturers of lifesaving drugs to engage in intentional price gouging whenever the need for a readily available, easily produce medication is in need. Given the current uncertainty within both the healthcare and economic arenas, neither patients, nor states can or should stand for being caught up in predatory pricing practices.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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