Generic version of Narcan drives down price
Ohio using savings to improve naloxone strategy
Naloxone prices continues to tumble, freeing up pubic health dollars to be spent elsewhere. The price drops will save the state of Ohio millions of dollars in the coming year, freeing up money for state plan to increase naloxone provided to high-risk demographics and underserved areas.
Harm Reduction Ohio reported last year that the introduction of a generic naloxone nasal spray had cut the price of brand name Narcan almost instantly. The downward trend in prices continues today, albeit at a slower rate. Competition is a wonderful thing.
Less than a year ago, Narcan nasal spray cost $75 per kit for governments and non-profit organizations The chart shows how much the state of Ohio now pays for naloxone, a drug that reverses opioid overdoses.
Quite a change from $75 per kit — and $100+ for naloxone bought with health insurance.
Note how the price gap between generic naloxone nasal spray and brand name Narcan nasal spray has grown to $8.97 per kit, up from $7.29 when the generic first came out.
Harm Reduction Ohio’s naloxone program
Harm Reduction Ohio, the state’s largest naloxone distributor, provided 42,000 kits in all 88 Ohio counties in 2022. Nearly all nasal spray provided now by Harm Reduction Ohio is the less costly generic version, made by Padagis Israel Pharmaceuticals in Yeruham, Israel, a town of 10,000 located in the Negev desert.
To fulfill consumer demand, Harm Reduction Ohio also distributes a lot of intramuscular naloxone (a generic naloxone injected into a large muscle, such as a thigh or arm), and Kloxxado, a higher dose nasal spray made in Ohio. We do not offer the ZIMHI high dose injector.
Nearly all Harm Reduction Ohio’s nasal spray comes from the Ohio Department of Health’s Project DAWN (Deaths Avoided with Naloxone) program. Our intramuscular naloxone is provided by DirectRelief, the pharmaceutical industry’s charity.
Last Year, Harm Reduction Ohio distributed 30,000 naloxone kits through our staff and network of 300+ volunteer lay distributors. Another 12,000 kits were provided to be who ordered online, an ordering system operated in partnership with NEXT Distro of New York City.
At current prices, the cost of the 42,000 naloxone kits shipped by Harm Reduction Ohio is about $1.4 million, down from $2.7 million under the old prices. The savings accrue to the state and others who provide naloxone to us at no cost, not to Harm Reduction Ohio.
Ohio’s Project DAWN
The savings are crucial for our state government’s plan to redirect money spent on naloxone away from the ridiculously high rice of the life-saving product and to getting naloxone accurately to where it’s needed.
The decline in naloxone’s price is the financial foundation for a new effort by the Ohio Department of Health and the Ohio Department of Mental Health and Addiction Services to redirect federal State Opioid Response money to an improved system of better targeting naloxone delivery to high-risk demographics and geographic areas. A new grant and contract system is being implemented in the first half of 2023 to run through late 2024. The introduction of generic naloxone and the price drop that followed has made this change possible.
Narcan going over the counter
A wild card in the future of naloxone prices is that Narcan will soon become an over-the-counter drug, available without a prescription.
Last Wednesday, two Food and Drug Administration advisory panels — one chaired by Ohio State University pharmacy professor Maria Coyle — unanimously recommended that Narcan be available over the counter. The FDA must decide by March 29. Approval is likely.
Today, Harm Reduction Ohio distributes naloxone under the prescription authority of Robert Masone, M.D., an anesthesiologist, addiction doctor and helicopter pilot who believed in us and our mission enough to put his medical license behind our effort. Nearly 100,000 naloxone kits and more than 5,000 overdoses were reversed under his signature.
Soon, a doctor’s signature will not be needed to provide naloxone.
What happens next nationwide is unclear — but Ohio, alone among states, shouldn’t have to worry about the bizarre world of pharmaceutical pricing.
Over-the-counter drugs almost always cost a lot less than prescription drugs. However, Narcan might be an exception, at least temporarily and in other states. Narcan will be the only over-the-counter naloxone available for a while. That monopoly could let Narcan keep its over-the counter price higher than it would be in a competitive marketplace.
Fortunately, Ohio shouldn’t have to worry about this, In a little notice legal changed passed in the recent lame duck session, the Ohio legislature passed a law that effectively turn all versions of naloxone into over-the-counter drugs, no matter what the FDA does. The Ohio Board of Pharmacy came up with the clever strategy to carve out a naloxone-only exception to the prescription requirement — and the legislature passed it at the last minute with little fanfare.
So, in Ohio, naloxone price competition should be robust. That will save consumers — especially state government, the biggest naloxone buyer — many millions of dollars every year.
It’s a little known story that naloxone has been a national leader in naloxone deregulation and distribution strategies since 2015. In other areas of overdose reduction, Ohio has been sadly behind the curve, a stagnation that has cost countless lives. But with naloxone, for reasons that aren’t entirely clear, Ohio has been forward-looking and creative.
Naloxone: the Ohio price
Ohio’s state pharmacy — run by the Ohio Department of Mental Health and Addiction Services — has done a good job negotiating relatively low prices for naloxone, especially lately when the market has become more competitive.
The chart above — shown again here, because, why not? — shows the current negotiated prices. The state pharmacy buys 200,000+ naloxone kits per year, giving them negotiating clout. Every dollar price reduction saves a lot of money.
Naloxone policy is something Ohio can be proud of, as is the work of Project DAWN program and the state pharmacy. Our state still live in a sea of grief: 5,000 overdose deaths each year. Now, we have been gifted $10 million+ from falling naloxone prices.
Our next job is to redirect this money wisely, in ways that make a real difference in saving lives. There’s some reason for optimism, that things might change, incrementally, for the better.
— Dennis Cauchon, President, Harm Reduction Ohio