Medicaid prescriptions for opioid overdose reversal drug naloxone have increased dramatically over the last decade, a new analysis shows.
Medicaid covered 3,328 naloxone prescriptions in 2010, a number that rose 71-fold to reach 236,388 in 2018, according to a new report from the Urban Institute. Generic naloxone products made up 99% of prescriptions in 2010, but just 11% in 2018.
As branded naloxone drugs increased in share, so too did the average rebate-adjusted price, rising by 29% from $17 in 2020 to $22 in 2018, according to the report.
"Medicaid programs across the country are engaged in upstream and downstream policies, including prevention and treatment efforts designed to reduce the need for naloxone," the researchers wrote. "However, harm reduction efforts need to be strengthened to save lives, and this includes increasing access to various life-saving naloxone products at stable, sustainable prices in Medicaid programs."
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The report notes that Medicaid enrollees may also have limited access to different formulations of naloxone, and that even with access they may be cost-prohibitive. Evzio, a brand-name naloxone auto-injector, for example, accounted for 12% of Medicaid naloxone prescriptions in 2015, while also accounting for 47% of total spending on naloxone in Medicaid that year.
An auto-injector would be an attractive choice for people who may have nasal abnormalities, which is common in people with opioid use disorder, Urban Institute said.
There are positive signs, too, according to the report. Nasal spray Narcan accounted for 89% of Medicaid prescriptions for naloxone in 2018, quickly capturing much of the market after being approved for Medicaid coverage in 2016.
In that same window, prices for Narcan after rebates also declined, the report found. Prices decreased by 23%, from $78 for a two-pack prescription in 2016 to $67 in 2018.
However, Narcan may not be the right option for every patient with opioid use disorder, so Medicaid programs should be eyeing ways to ensure Medicaid patients are not left with limited options.
"Without new federal policies regulating prices and/or promoting robust price competition, including new generic competition, Medicaid enrollees’ options may be limited, which could worsen the overdose crisis," the researchers wrote.