Beruflich Dokumente
Kultur Dokumente
of Saving a Life
How Price Gouging of Naloxone
has put New Yorkers at Risk
NOVEMBER 2016
1,850
1,800
1,750
1,700
Number of Deaths
1,650
1,600
1,589
1,550
1,500
1,450
2013
2014
Naloxone Kit
Daniel Wermiling, A Response to the Opioid Overdose Epidemic: Naloxone Nasal Spray, US National Library of
Medicine: National Institutes of Health, Aug. 1., 2012,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668569/#R17
2
NPR, Price Soars for Key Weapon Against Heroin Overdoses, Sept. 10, 2015.
According to the State Health Department, Naloxone was administered during 11,992 emergency
medical service (EMS) calls in 2014, and administered during 7,649 EMS calls in 2013,
representing a 57% increase.3
7,649
Number of Times Naloxone Was
Administered
6,000
4,000
2,000
0
2013
2014
The heroin and opioid epidemic in New York, while ravaging our communities, has also led to
reports of unscrupulous pharmaceutical manufacturers capitalizing on the success of Naloxone.
This life saving antidote blocks opioid receptors in the brain and can reverse the effects of an
opioid overdose.
In 2014, the New York State Senate created a bi-partisan task force to tackle the heroin and
opioid epidemic head on. As Co-chair of the 2014 task force, Senator Carlucci traveled across
the state, hearing from experts and New Yorkers affected by this epidemic. Since 2014, Senator
Carlucci has hosted Naloxone trainings and town halls with residents of the Hudson Valley, in
which more than 400 people have been trained in the use of Naloxone in workshops he has
hosted.
Recently, in June 2016, Senator Carlucci successfully negotiated the passage of his bill,
S.6346B, which was subsequently signed into law. The bill requires chain pharmacies with at
least twenty locations to register with the Department of Healths overdose prevention program
and to dispense opioid antagonists such as Naloxone, enhancing the publics access to the drug at
pharmacies across the state. Further, to combat the rise of heroin overdoses and addiction,
Senator Carlucci advocated for comprehensive legislation that was signed into law to increase
access to treatment, break down barriers from insurance carriers, and permit doctors to
administer naloxone.
3
James T. Mulder, Cost of Nalaxone, the Life-saving Drug in Heroin Battle, Soars as Epidemic Grows, SYRACUSE
POST-STANDARD, Oct 20, 2016.
5
Brian Albright, Navigate the Nalaxone Economy, Behavioral Healthcare, Aug. 2, 2016,
http://www.behavioral.net/article/prescription-drug-abuse/navigate-naloxone-economy?page=2
In 2014, Attorney General Schneiderman wrote a letter to Amphastar, criticizing its increase in
Naloxone pricing and asking for further information about the price increase. In the resulting
settlement in 2015, the company agreed to provide a $6 rebate per dose for customers, with an
additional rebate to be offered to offset any future wholesale price increase of the drug.6 That
agreement was extended in 2016 for an additional year and covers purchases of Naloxone by the
State Department of Health, the City of New York, all counties in the state, 479 CVS stores
across the state, and drug treatment centers.7 On November 3, 2016, the Attorney General
announced another one-year extension of the agreement, through January 2018. Schneidermans
settlement is one of many lawsuits that Amphastar is settling with attorney generals across the
country, by providing each state with a $6 rebate per dose.
$41
$40
$33
$35
$30
$25
$19
$20
$15
$12
$10
$5
$0
October 2011
June 2014
October 2014
June 2015
Naloxone Price
Adapt Pharma received approval from the FDA on November 18, 2015, for an all-in-one nasal
spray device, which does not need an atomizer attached. This nasal spray device was
trademarked as Narcan.8 Each Narcan package contains two single-use nasal sprays, with each
single-use spray containing 4 milligrams of Naloxone. Narcan began selling at the end of 2015
for $125 for its two-dose package with nearly a half-price cost to first responders and customers
without insurance, at $75.9 Narcan has not increased in price since it began sales in 2016. 10
US House of Representatives, Judiciary Subcommittee on Regulatory Reform, Commercial and Anti-trust Law,
Treating the Opioid Epidemic: The State of Competition in the Markets for Addiction Medicine, Testimony of Mark
Merritt, Sept, 22, 2016, https://judiciary.house.gov/wp-content/uploads/2016/09/Merritt-Testimony.pdf
9
David Armstrong, FDA Approves Nasal Spray that Reverses Opioid Overdose, Stat,
https://www.statnews.com/2015/11/18/fda-nasal-spray-overdose/
10
Krystal Alexander, Before the EpiPen and Daraprim there was Nalaxone- Generic Price Gouging Has a History,
AMERICAN COUNCIL ON SCIENCE & HEALTH, Sept. 2, 2016. http://acsh.org/news/2016/09/02/epipen-and-daraprimthere-was-naloxone-%E2%80%94-generic-price-gouging-has-history-9940
11
Sarah Karlin-Smith, Price Spikes for Life Saving Drug, Politico, http://www.politico.com/story/2016/05/drugprices-addiction-223192
$4,500
$4,000.00
$3,750
$3,500.00
$3,000.00
$2,500.00
$2,000.00
$1,500.00
$1,000.00
$500.00
$750
$690.00
$0.00
Nov-14
Nov-15
Feb-16
Sep-16
Delivery Type
Starting Price
Current Price
Price % Increase
Pfizer
Injection
1717%
Kaleo (Evzio)
Auto-injection
652%
Amphaster
342%
Adapt (Narcan)
Nasal Spray
0%
Mylan
Injection
0%
12
US House of Representatives, Judiciary Subcommittee on Regulatory Reform, Commercial and Anti-trust Law,
Treating the Opioid Epidemic: The State of Competition in the Markets for Addiction Medicine, Testimony of Dr.
Eric Kretchem https://judiciary.house.gov/wp-content/uploads/2016/09/Ketcham-Testimony-.pdf
Other Drugs
Epinephrine
Mylan is the main manufacturer of EpiPens. The product was sold in 2007 at $93.88 and sold in
2009 at $103.50 for a 2-pack. The price of a set rose to $461 in May 2015 and was sold at
$608.61 in May 2016.13 Mylan also offers a $100 coupon for the product. Epipens may expire
after just a year, requiring customers to get new EpiPens on almost an annual basis. Attorney
General Schneiderman is currently investigating Mylan for antitrust violations. The Attorney
Generals preliminary review revealed that Mylan inserted anti-competitive terms into its sales
contracts with school districts, resulting in the state paying artificially high prices for the
medicine.
EpiPen 2-Pak Price Increase (adjusted for inflation)
Date
EpiPen Price
November 1, 2004
$106.32
$106.96
$107.76
$108.96
$110.18
$139.42
August 3, 2010
$150.76
$176.50
$229.52
$273.24
May 2, 2014
$354.94
May 1, 2015
$468.06
$537.80
$608.61
13
Tara Parker Pope, EpiPen Price Rise Sparks Concern for Allergy Sufferers, Aug. 22, 2016, NY Times,
http://well.blogs.nytimes.com/2016/08/22/epipen-price-rise-sparks-concern-for-allergy-sufferers/
14
Ike Swetlitz, High Price of EpiPens Spurs Consumers, EMTs to resort to syringes for Allergic Reactions, Stat,
July 6, 2016
Buprenorphine
Buprenorphine was approved by the FDA in 1985 and is used to treat heroin addiction. The
effects of the medication are weaker than methadone and heroin, causing only a limited response
to the central nervous system, and is considered a safer alternative than methadone by the DEA.
In 2012, at least one million people received a subscription for a brand name or generic of
Buprenorphine.
Wholesale prices for 8 miligram generic buprenorphine tablets have increased from $2.37 per
tablet to $5.57 per tablet. A 30-day supply of the generic drug costs $334.20 with patients
needing to take two daily tablets. Buprenorphine is also sold in combination with Naloxone at a
price of $470 for the brand name drug sold by Suboxone, Zubsolv, and Bunavi. Generic
versions of the drug are more expensive than the brand names with generics being sold at $10.42
per tablet and $625.28 for a 30-day supply.15
15
Conclusion
The heroin and opioid epidemic continues to ravage our communities at an unprecedented rate.
Although legislative efforts and public awareness events have made a difference in the fight
against this epidemic, more work is needed to protect our communities. Pharmaceutical
companies must be held accountable where suspected price gouging has occurred of vital
prescriptions, including with price increases of Naloxone. Passage of crucial price gouging
legislation will help achieve that goal.
10