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Outrage of the Month: Pharma's Price Gouging Forces Rationing of Lifesaving Opioid Overdose Antidote

Health Letter, June 2018

Michael Carome, M.D.

Image: AppleZoomZoom/Shutterstock.com

On April 5, U.S. Surgeon General Jerome Adams issued an advisory urging more Americans to carry naloxone, a lifesaving medication used to rapidly reverse opioid overdoses. Naloxone, which is available as an easy-to-use auto-injector and as a nasal spray, routinely is carried by many first responders, such as paramedics and police. The Surgeon General recommended that more individuals, including those at risk of opioid overdoses and their family and friends, keep the drug on hand.

The Surgeon General’s advisory comes at a time when the rate of opioid overdose deaths is rapidly rising. According to the Centers for Disease Control and Prevention, there were more than 42,000 opioid-related deaths in the U.S. in 2016, a fivefold increase compared with 1999.

Although the Surgeon General’s advisory was a welcome development, unaffordable prices are a major hurdle to providing easy-to-use naloxone products to all households throughout the U.S that should have immediate access to them.

The drug naloxone itself is available in generic form and can be purchased from suppliers in India for as little as 15 cents per dose.[1] However, Narcan — the nasal spray version of naloxone — is under patent until 2035.[2] Until then, only one company — Adapt Pharma — can make it, which gives that corporation monopoly power. Narcan has a list price of $75 per dose and is available at half this price to public providers, such as city and county health departments.[3] Similarly, Evzio — the only naloxone auto-injector product marketed in the U.S. — is under patent until 2034.[4] The list price for Evzio is more than $4,000, and it is newly available to public providers at $180 per dose.[5]

Even with the public-provider discounts, local governments still lack the resources to obtain sufficient quantities of naloxone for all citizens who need it. As a result, city and county health departments are forced to ration this lifesaving antidote.

On May 3, Public Citizen and the Baltimore City Health Department petitioned the Trump Administration to use a rarely invoked authority to lower the price of the easy-to-use naloxone products. Under “government use authority,” the U.S. government can procure generic versions of on-patent drugs from other manufacturers. If the Trump administration invoked this authority, state and local agencies could act as agents of the federal government and buy generic versions of Narcan and Evzio directly from these manufacturers at markedly reduced prices. The federal government also could buy generic versions of these products and supply them to local health and law enforcement programs.

At a news conference announcing the petition from Public Citizen and the Baltimore City Health Department, Dr. Leana Wen, health commissioner of Baltimore, highlighted the hurdles her department faced in getting naloxone to people who need it:

Every week, we count the doses [of naloxone] we have left and make hard decisions about who will receive the medication and who will have to go without. The surgeon general emphasized the importance of community members who may come into contact with people at risk for opioid overdose to know how to use naloxone and have it in reach…

We have worked hard to enact policies to make naloxone accessible. We know what works. Now we need the resources. The federal government needs to follow the surgeon general’s policy guidance with specific and substantial funding commitments and to back up the surgeon general’s advisory. Imagine if this were Ebola, and hundreds of people were dying across the country every single day. There would be no question that the federal government would step in and provide the front lines the resources needed to save lives.

We are in the middle of a national epidemic. We should not be priced out of the ability to save lives.

As Robert Weissman, president of Public Citizen, succinctly stated on May 3, the choice is simple: the Trump administration “can choose to lower prices and save lives. Or they can choose to perpetuate the rationing of lifesaving treatments and avoid offending Big Pharma.”

[1] Public Citizen. Trump administration should use rarely invoked authority to expand access to opioid overdose antidote. May 3, 2018. https://www.citizen.org/media/press-releases/trump-administration-should-use-rarely-invoked-authority-expand-access-opioid. Accessed May 23, 2018.

[2] Ibid.

[3] Public Citizen. Trump administration should use rarely invoked authority to expand access to opioid overdose antidote: Full statements from speakers at the Baltimore press conference. May 3, 2018. https://www.citizen.org/media/press-releases/trump-administration-should-use-rarely-invoked-authority-expand-access-opioid-0#Hopkins. Accessed May 23, 2018.

[4] Public Citizen. Trump administration should use rarely invoked authority to expand access to opioid overdose antidote. May 3, 2018. https://www.citizen.org/media/press-releases/trump-administration-should-use-rarely-invoked-authority-expand-access-opioid. Accessed May 23, 2018.

[5] Public Citizen. Trump administration should use rarely invoked authority to expand access to opioid overdose antidote: Full statements from speakers at the Baltimore press conference. May 3, 2018. https://www.citizen.org/media/press-releases/trump-administration-should-use-rarely-invoked-authority-expand-access-opioid-0#Hopkins. Accessed May 23, 2018.