Study: Costs of Naloxone a Barrier for Uninsured Patients

Out-of-pocket costs decreased for those with insurance but rose for those without insurance, finds RAND study.

An observational study of pharmacy claims has found that the costs of naloxone, which is used to reverse opioid overdose, grew substantially beginning in 2016, and those primarily impacted by the rising costs are uninsured patients, according to a new study published in JAMA Health Forum.

Conducted by the nonprofit RAND Corp., the study found that the average out-of-pocket cost per naloxone prescription among those who have health insurance declined by 26% from 2014 to 2018, while out-of-pocket costs increased by more than 500% for people who are uninsured. Uninsured Americans are a vulnerable population that represent about 20 percent of adults with an opioid-use disorder and nearly one-third of opioid overdose deaths.

“The price of naloxone is almost certainly an impediment to more-widespread adoption among the uninsured,” Evan D. Peet, Ph.D., study's lead author and an economist at RAND, said in a press release.

Researchers from RAND and the University of Southern California examined more than 700,000 prescription records from 2010 to 2018 for both generic and name-brand naloxone to examine trends in out-of-pocket costs. The sample included information from more than 70% of the nation’s retail pharmacies.

Prescriptions filled for naloxone increased sharply over the study period. While the sample saw 11,432 naloxone prescriptions filled during 2010, the number grew to 386,249 in 2018. Investigators said naloxone claims grew following the passage new laws in many states and the introduction of Narcan, and Narcan’s nasal spray made it easier to administer.

While naloxone distribution rose among the insured, naloxone access among the uninsured did not experience similar gains. Distribution rose among those with Medicare VA/Tricare and Medicaid insurance, and among those with private insurance starting in 2017 but not those without insurance.

Researchers say cost is likely reason for less use of naloxone among the uninsured. As use of naloxone increased, the out-of-pocket costs fell for most people with health insurance, while it increased for those who are uninsured.

In 2014, the average out-of-pocket cost per naloxone prescription among insured people was $27, while it was $35 for those who were uninsured. By 2018, the average out-of-pocket cost per prescription for naloxone among the uninsured was $250. The same year, the average out-of-pocket per naloxone prescription for the insured was $18.

There were several limitations of the study. The first is that the databased used, Symphony Health, was missing prescriptions filled in about 28% of retail pharmacies in the United States. Most naloxone is not dispensed through pharmacies but, instead, to hospitals, community-based programs, first responders, and other organizations. Researchers didn’t assess naloxone dispensing from nonpharmacy settings, and it is possible, they speculated that naloxone dispensed in nonretail settings disproportionately targets the uninsured population. They also only looked at dispensing and not actual use.

Support for the study was provided by the Centers for Disease Control and Prevention and the National Institute on Drug Abuse.