State questions rise in overdose drug price
Naloxone vital in emergency efforts
Attorney General Maura Healey is demanding that companies selling naloxone in Massachusetts explain why the cost of the drug, which is used to reverse heroin overdoses, has skyrocketed since former governor Deval Patrick declared a public health emergency a year ago.
The drug, often marketed under the brand name Narcan, has become a critical tool for emergency workers who use it to revive overdose victims. Without Narcan, thousands of overdoses during the past few years would have resulted in deaths, authorities have said.
To help ensure that distributors are not taking advantage of a sudden surge in demand, Healey’s office last week asked the distributors to provide detailed records of all naloxone sales to public entities in Massachusetts since April 1, 2014, less than a week after Patrick’s declaration made the drug available to all first responders.
Since then, price increases “have strained access to this life-saving medication at exactly the moment when it is most needed,” the companies were told in certified letters. “Our office has heard regularly from local law enforcement and public health workers worried about their ability to maintain supplies.”
In Plymouth, the cost of Narcan more than doubled to $44.54 a dose in December from $18.50 in February 2014. “It’s eating into the budget,” said Fire Chief G. Edward Bradley.
In Needham, the price rose to $66.89 this month, according to Norfolk District Attorney Michael Morrissey. In Walpole, the cost was $37.50 in January, he said.
Healey’s office sent certified letters requesting answers by April 30 to Moore Medical of Farmington, Conn.; Bound Tree Medical of Dublin, Ohio; McKesson Corp. of San Francisco; and Southeastern Emergency Equipment of Wake Forest, N.C.
“Deaths caused by overdoses of heroin or other opiates have increased 10 times in the last decade,” according to the letter, written by Eric Gold, assistant attorney general in the health care division. “Opiate abuse and addiction are ravaging communities in all parts of Massachusetts.”
Healey’s office has asked the companies to provide electronic spreadsheets that list all Massachusetts public entities that have purchased naloxone from them since April 1, 2014, along with the number of units of naloxone, dates, and price for each purchase.
Kristin Hunter, a spokeswoman for McKesson Corp., told the Globe that the company “does not set wholesale prices or the retail drug prices paid by consumers or health plans.”
Those prices often are set by the manufacturer. Staff from Healey’s office identified Amphastar Pharmaceuticals of Rancho Cucamonga, Calif., as the producer of much of the naloxone used in Massachusetts, and said they have been in discussions with the company about pricing since February.
Amphastar officials did not return repeated phone calls from the Globe requesting comment.
Morrissey, the Norfolk district attorney, said his staff contacted Healey earlier this year after hearing complaints from police and fire chiefs about sudden spikes in naloxone costs — many of which varied from community to community.
“We sent that information to the attorney general to see if there’s potential for price gouging,” Morrissey said.
Healey’s investigation comes at a time when naloxone is being widely used by police officers, firefighters, and other emergency workers across the state. Before Patrick’s declaration, many first responders had been barred from administering the drug by state regulations written before the crisis.
Now, naloxone is considered indispensable. In Plymouth, naloxone was used 169 times in 2014, when the town responded to 313 overdoses and recorded 15 drug-related deaths.
In Quincy, naloxone was administered 75 times in 2014, said Detective Lieutenant Patrick Glynn. The city recorded 22 drug-related deaths last year.
A grant from the state Department of Public Health is helping Quincy purchase the drug this year, so the city is not feeling the pinch reported in other, smaller communities. However, Glynn said he has noticed a doubling of naloxone’s price in the past eight months.
In Stoughton, Police Chief Paul Shastany said he had “no explanation” for the price increase.
“It’s better than blue-chip stock,” he said.
Morrissey said his office is helping soften the burden by providing up to $1,000 per community to buy naloxone. The money is being diverted from assets seized in his office’s drug cases, which means that the pool of available funds will fluctuate.
However, Morrissey said, “what better way to spend forfeiture money then to keep people alive.”
Healey’s scrutiny of naloxone prices is one piece of what she said will be a broad, collaborative effort to stem the opioid crisis, which is killing hundreds of people a year from all regions and income groups across Massachusetts.
“Urgent isn’t even a word for it,” Healey said during a wide-ranging interview last week in her Beacon Hill office.
Healey’s plans include a crackdown on abuses of prescription painkillers; advocating for more beds for addiction treatment; and broader awareness in the schools about the dangers of opioids.
“We’ve set to work on this right away,” said Healey, who called the crisis the top priority of her sprawling department and a topic at every staff meeting.
One crucial step, the attorney general said, is keeping prescription painkillers in the hands of those patients who need them.
To achieve that goal, Healey said, a state program that tracks who is prescribing the drugs and who is receiving them should be made more user-friendly. Some doctors have complained that the system is cumbersome and time-consuming, she said.
The system, called the Prescription Drug Monitoring Program, is deemed an important means of identifying people who visit several doctors to obtain as many painkillers as possible in a short period of time. The physicians who enable this behavior also are being targeted through the program.
“We’ll certainly see more cases against MDs or individuals engaged in unlawful, illegal, and deceptive practices,” Healey said.