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Rates and Costs of Dispensing Naloxone to Patients at High Risk for Opioid Overdose in the United States, 2014–2018

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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.

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Data Sharing

The source data for this study were licensed by Brigham and Women’s Hospital from Optum® Clinformatics®, and hence we are not allowed to share the licensed data publicly.

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Funding

The primary source of funding for this study was provided by Arnold Ventures. Dr Kesselheim also receives grant support from the Harvard-MIT Center for Regulatory Science.

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Authors and Affiliations

  1. From the Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 1620 Tremont St., Suite 3030, Boston, MA, 02120, USA

    Rachel E. Barenie, Joshua J. Gagne, Aaron S. Kesselheim, Ajinkya Pawar, Angela Tong, Jing Luo & Brian T. Bateman

  2. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital and Harvard Medical School, 1620 Tremont St., Suite 3030, Boston, MA, 02120, USA

    Brian T. Bateman

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  1. Rachel E. Barenie
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  2. Joshua J. Gagne
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  4. Ajinkya Pawar
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  5. Angela Tong
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  6. Jing Luo
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Corresponding author

Correspondence to Rachel E. Barenie.

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Conflict of interest

Rachel Barenie serves as a clinical consultant to Alosa Health for opioid use disorder and pain management-related work. Joshua Gagne has received salary support from grants from Eli Lilly and Company and Novartis Pharmaceuticals Corporation and was a consultant to Aetion, Inc, and Optum, Inc., all for unrelated work. Aaron Kesselheim reports serving as an expert witness for the class of state plaintiffs in the multidistrict opiate litigation (2018–2019). Jing Luo has served as a clinical consultant to Alosa Health for opioid use disorder and pain management-related work. Jing Luo is now an Assistant Professor of Medicine at the University of Pittsburgh in Pittsburgh, PA and receives research support from the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR001856. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Department of Veterans Affairs. Brian Bateman serves as a consultant to Alosa Health for opioid use disorder and pain management-related work and Aetion, Inc and Merck for Mothers for unrelated work. Brian Bateman is a co-investigator on grants to his institution from Eli Lilly, GSK, Pfizer, Pacira, and Baxalta. Ajinkya Pawar and Angela Tong have no conflicts of interest that are directly relevant to the content of this study.

Ethics approval

The Brigham and Women’s Hospital waived the need for informed consent for this study.

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Barenie, R.E., Gagne, J.J., Kesselheim, A.S. et al. Rates and Costs of Dispensing Naloxone to Patients at High Risk for Opioid Overdose in the United States, 2014–2018. Drug Saf 43, 669–675 (2020). https://doi.org/10.1007/s40264-020-00923-6

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