Prices jump as heroin antidote use increases

The growing popularity of drugs used to treat heroin overdoses has resulted in costs that have quadrupled in the past two years in some cases.

Experts say prices have escalated for such drugs as naloxone, Narcan or Evzio, which work to block the receptors in the brain that are stimulated by opioids and allow users who are overdosing to begin breathing again.

"Right now we're probably paying around $40 for a dose. Two years ago we may have been paying between $5 and $10," said Phil Williams, administrative director of pharmacy services for Edward Elmhurst Healthcare. "It's been a pretty significant increase."

Pharmacists and anti-heroin advocates predict more price increases, just as first responders across the state are being required to carry the drugs under a new law passed when the legislature overrode an amendatory veto from Gov. Bruce Rauner.

Illinois is far from the only state with a heroin problem, which is part of what's driving the increased demand and rising prices, Williams said.

"I think you've got the manufacturers seeing an opportunity with unfortunately what's happening in a lot of communities around the country that we've got a heroin epidemic," Williams said. "It's an opportunity for them to say we've got a captured market and we can increase the cost and drive our profit margins."

Antidote expansion

Naloxone has been FDA-approved to counteract the effects of an opioid overdose since 1971, and it's been stocked in ambulances and emergency rooms for years.

Williams called naloxone the "gold standard antidote" for opioid overdoses and said need for the drug is growing.

"We're seeing more and more patients that are coming to our emergency room with a potential heroin overdose, so we're using more of the drug," said Williams, whose health system provides naloxone for ambulances in Naperville, Elmhurst and other towns. "We're using more of it and it's costing more, so it does have a negative financial impact."

As concern about heroin overdoses has increased, so has naloxone use outside hospitals.

Initiatives in DuPage, Lake and Kane counties to equip police with the drug are leading the push for better naloxone availability, along with nonprofits that are teaching drug users and their parents how to administer it.

DuPage County was the first to get started in early 2014, and now 2,100 trained officers each are carrying two naloxone doses in nasal spray form, Coroner Richard Jorgensen said.

Each dose costs $16. The health department buys injectable naloxone from Hospira, one of a few companies that make generic forms of the drug, then couples it with an atomizer to turn it into a mist that can be inhaled.

Fewer producers

Jorgensen said he heard naloxone prices could be on the rise just as DuPage is beginning to replace doses that are approaching their two-year expiration date.

Williams said overall inflation in drug prices is partially to blame, along with the fact there are no longer as many generic manufacturers of naloxone. Williams said he knows of three - Hospira, Amphastar Pharmaceuticals and kaléo - but there used to be at least half a dozen.

Hospira has been selling naloxone in injectable form since the mid-1980s, but a spokesman was vague about the price, saying a dose costs about the same as a fast-food meal for four. A spokesman for Amphastar Pharmaceuticals did not return calls.

Producer consolidation could be one driver of naloxone price increases, but early results from a year and a half of police administering the drug in DuPage prove it's worth the cost, Jorgensen said: 71 lives have been saved since the program started - 33 in 2014 and 38 so far this year.

"It's a lifesaving tool, so we need to make it as affordable as possible, especially for people who can't afford much," said Chelsea Laliberte, founder of Live 4 Lali, an anti-heroin education nonprofit in Arlington Heights.

No more freebies?

Laliberte's organization has helped thousands of police, parents and drug users get an easy-to-use form of naloxone called Evzio. The drug is delivered in an automatic injector similar to an EpiPen for allergic reactions that even talks to users, telling them exactly what to do.

Laliberte got 6,000 free doses of Evzio from its manufacturer, kaléo, when she helped form the Lake County Opioid Initiative in early 2014.

Patients who have received Evzio and been billed for it through their insurance pay a median out-of-pocket price of $17 for two doses, according to the company. But kaléo donates to groups such as Live 4 Lali and offers a patient assistance program to ensure those who need the lifesaving medication are able to get it.

After equipping all officers in Lake County late last year and passing along 500 doses to officers in Kane County in July, Laliberte said she has about 1,000 doses of Evzio left.

She's thrilled to provide free Evzio and training to anyone who shows up at Live 4 Lali's office at 3275 N. Arlington Heights Road, suite 403B.

Tim Ryan of Naperville, who runs A Man in Recovery Foundation, also says he hands out doses of Evzio he gets from Laliberte "like wildfire" as he works with addicts and those in recovery.

But future cost increases could cause problems for Live 4 Lali's Evzio distribution. Laliberte said she knows there will be more competition for any free medicine kaléo provides because more anti-heroin efforts have launched. And her stockpile is soon to run out - likely before the end of the year.

"To us, it's not a huge problem, but we know it will become one as this isn't going to be available forever," Laliberte said.

Someday, pharmacies will begin selling naloxone over the counter thanks to another provision - called Lali's Law - in the state's recently approved Heroin Crisis Act. But Laliberte expects the rollout to take a long time. She doesn't know how much the drug will cost once over-the-counter sales begin or how customer payment will work with insurance companies.

"It's going to be a very long implementation process," Laliberte said. "The good news is this will happen one way or the other."

  DuPage County health officials trained police officers early last year on how to administer naloxone, a drug that reverses the effects of a heroin overdose. Now, all 2,100 officers in the county each carry two doses of naloxone. Daniel White/
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