Rates and Costs of Dispensing Naloxone to Patients at High Risk for Opioid Overdose in the United States, 2014–2018
- 16 March 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Drug Safety
- Vol. 43 (7), 669-675
- https://doi.org/10.1007/s40264-020-00923-6
Abstract
Introduction Clinical practice guidelines recommend co-prescribing naloxone to patients at high risk of opioid overdose, but few such patients receive naloxone. High costs of naloxone may contribute to limited dispensing. Objective The aim of this study was to evaluate rates and costs of dispensing naloxone to patients receiving opioid prescriptions and at high risk for opioid overdose. Methods Using claims data from a large US commercial insurance company, we conducted a retrospective cohort study of new opioid initiators between January 2014 and December 2018. We identified patients at high risk for overdose defined as a diagnosis of opioid use disorder, prior overdose, an opioid prescription of ≥ 50 mg morphine equivalents/day for ≥ 90 days, and/or concurrent benzodiazepine prescriptions. Results Among 5,292,098 new opioid initiators, 616,444 (12%) met criteria for high risk of overdose during follow-up, and, of those, 3096 (0.5%) were dispensed naloxone. The average copayment was US$24.83 for naloxone (standard deviation [SD] 67.66) versus US$9.74 for the index opioid (SD 19.75). The average deductible was US$6.18 for naloxone (SD 27.32) versus US$3.74 for the index opioid (SD 25.56), with 94% and 88% having deductibles of US$0 for their naloxone and opioid prescriptions, respectively. The average out-of-pocket cost was US$31.01 for naloxone (SD 73.64) versus US$13.48 for the index opioid (SD 34.95). Conclusions Rates of dispensing naloxone to high risk patients were extremely low, and prescription costs varied greatly. Since improving naloxone’s affordability may increase access, whether naloxone’s high cost is associated with low dispensing rates should be evaluated.Keywords
Funding Information
- Arnold Ventures
This publication has 12 references indexed in Scilit:
- Vital Signs: Pharmacy-Based Naloxone Dispensing — United States, 2012–2018Morbidity and Mortality Weekly Report (MMWR), 2019
- Naloxone Co-prescribing to Patients Receiving Prescription Opioids in the Medicare Part D Program, United States, 2016-2017JAMA, 2019
- Naloxone Prescriptions Among Commercially Insured Individuals at High Risk of Opioid OverdoseJAMA Network Open, 2019
- Prices of Generic Drugs Associated with Numbers of ManufacturersThe New England Journal of Medicine, 2017
- The Rising Price of Naloxone — Risks to Efforts to Stem Overdose DeathsThe New England Journal of Medicine, 2016
- CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016MMWR. Recommendations and Reports, 2016
- ForewordMMWR Supplements, 2016
- Opioid switching from and to tapentadol extended release in cancer patients: conversion ratio with other opioidsCurrent Medical Research and Opinion, 2013
- The Epidemiology of Prescriptions Abandoned at the PharmacyAnnals of Internal Medicine, 2010
- De Facto Long-term Opioid Therapy for Noncancer PainThe Clinical Journal of Pain, 2008