Naloxone Out-of-Pocket Expenses May Present Barrier for Uninsured

For uninsured individuals, the out-of-pocket cost of naloxone may be an increasingly substantial barrier to its use, according to the results of an observational study published in JAMA Health Forum.

Data on naloxone prescription claims were sourced from the Symphony Health nationwide prescription claims database between 2010 and 2018, and evaluated for trends in annual counts and out-of-pocket costs.

During the study period, 719,612 naloxone claims were documented (Narcan, n=501,568; generic naloxone, n=172,894; Evzio, n=45,150).

In 2010, all 11,432 naloxone claims were for the generic formulation and were paid for by private insurers (n=5613), fully out-of-pocket (n=3595), Medicare (n=2216), and Medicaid (n=8). In 2018, 386,249 claims for all types of naloxone (90.2% Narcan, 7.6% generic, 2.2% Evzio) were paid for by Medicare (n=132,370), private insurers (n=119,886), Medicaid (n=118,881), out-of-pocket (n=8809), and Veterans Affairs (VA)/TRICARE (n=6303).

In 2015 and 2016, the rate of naloxone claims increased rapidly, coinciding with many states passing naloxone access laws and the approval by the US Food and Drug Administration of Narcan. Among all patients, the slowest growth rate in naloxone claims was observed among uninsured individuals, which may be due to cost. In 2014, the average out-of-pocket cost for naloxone was $3.14 for Medicaid beneficiaries, $8.11 for Medicare beneficiaries, $27.97 for individuals with private insurance, $35.39 for individuals without insurance, and $103.07 for VA/Tricare beneficiaries. Pooling the entire population of insured individuals, filling a naloxone prescription cost an average of $6.93 more for uninsured individuals.

Between 2015 and 2018, the out-of-pocket expenses changed substantially, in which the out-of-pocket cost for insured individuals decreased by 26.15% while increasing by 506.33% to a mean of $249.97 in 2018 for uninsured individuals.

Stratified by brand, mean out-of-pocket costs between 2014 and 2018 for the insured population were $8.16 for generic naloxone, $13.48 for Narcan, and $25.81 for Evzio. Among the uninsured population, mean out-of-pocket costs were $67.99 for generic naloxone, $73.62 for naloxone, and $1089.17 for Evzio.

This study may have been limited, as 83% of the market share for naloxone was sold to nonretail settings in 2017, which may disproportionately target the uninsured population.

This study identified a large increase in access to naloxone through pharmacies in 2015. The growth in naloxone claims was smallest among individuals who were not insured. The out-of-pocket costs for naloxone remain higher for the uninsured and may represent a barrier to access among this population.

Investigators suggest that “policy makers could consider implementing broad price subsidies for naloxone purchases, regulating co-pays for insured patients, and issuing coupons targeting uninsured patients.”