RAND Corporation, Pittsburgh, Pennsylvania.
RAND Corporation, Arlington, Virginia.
JAMA Health Forum. 2022 Aug 5;3(8):e222663. doi: 10.1001/jamahealthforum.2022.2663.
Improving access to naloxone is a critical component of the nation's strategy to curb fatal overdoses in the opioid crisis. Standing or protocol orders, prescriptive authority laws, and immunity provisions have been passed by states to expand access, but less attention has been given to potential financial barriers to naloxone access.
To assess trends in out-of-pocket (OOP) costs for naloxone and examine variation in OOP costs by drug brand and payer.
DESIGN, SETTING, AND PARTICIPANTS: This observational study analyzed US naloxone claims data from Symphony Health and associated OOP costs for individuals filling naloxone prescriptions by drug brand and payer between January 1, 2010, to December 31, 2018. The data were analyzed from March 31, 2021, to April 12, 2022.
The main measures were trends in annual number of naloxone claims (overall, by payer, and by drug brand) and mean annual OOP costs per claim (overall, by payer, and by drug brand).
Of 719 612 naloxone claims (172 894 generic naloxone, 501 568 Narcan, and 45 150 Evzio) for 2010 through 2018, the number of naloxone claims among insured patients began rapidly increasing after 2014; at the same time, the mean OOP cost of naloxone increased dramatically among the uninsured population. Comparing 2014 with 2018, the mean OOP cost of naloxone decreased by 26% among those with insurance but increased by 506% among uninsured patients. For the uninsured population, the impediment of cost was even larger for certain brands of the drug. In 2016, the mean OOP cost for Evzio among uninsured patients rose to $2136.37 (a 2429% increase relative to 2015) compared with the mean cost of generic naloxone, $72.88, and the cost of Narcan in its first year, $87.95. Throughout the period, the mean OOP costs paid by uninsured patients were higher for Evzio at $1089.17 (95% CI, $884.17-$1294.17) compared with $73.62 (95% CI, $69.24-$78.00) for Narcan and $67.99 (95% CI, $61.42-$74.56) for generic naloxone.
In this observational study, the findings indicated that the OOP cost of naloxone had been an increasingly substantial barrier to naloxone access for uninsured patients, potentially limiting use among this population, which constituted approximately 20% of adults with opioid use disorder.
改善纳洛酮的可及性是国家遏制阿片类药物危机中致命过量战略的重要组成部分。为了扩大获取途径，各州已经通过了关于站立或协议命令、规定性授权法和豁免条款，但对纳洛酮获取的潜在财务障碍的关注较少。
评估纳洛酮自付费用的趋势，并研究按药物品牌和支付方划分的自付费用的变化。
设计、设置和参与者：本观察性研究分析了 Symphony Health 的美国纳洛酮索赔数据以及 2010 年 1 月 1 日至 2018 年 12 月 31 日期间个人按药物品牌和支付方使用纳洛酮处方的相关自付费用。数据分析于 2021 年 3 月 31 日至 2022 年 4 月 12 日进行。
主要措施是每年纳洛酮索赔数量（总体、按支付方和按药物品牌）和每例索赔的年平均自付费用（总体、按支付方和按药物品牌）的趋势。
在 2010 年至 2018 年期间，有 719612 例纳洛酮索赔（172894 例通用纳洛酮、501568 例 Narcan 和 45150 例 Evzio），在 2014 年之后，保险患者的纳洛酮索赔数量开始迅速增加；与此同时，在没有保险的人群中，纳洛酮的平均自付费用大幅增加。与 2014 年相比，2018 年保险患者的纳洛酮自付费用降低了 26%，但没有保险的患者增加了 506%。对于没有保险的人群来说，某些药物品牌的药品成本障碍更大。2016 年，无保险患者的 Evzio 平均自付费用上升至 2136.37 美元（与 2015 年相比增长了 2429%），而通用纳洛酮的平均费用为 72.88 美元，Narcan 的第一年费用为 87.95 美元。在整个期间，无保险患者的 Evzio 平均自付费用为 1089.17 美元（95%CI，884.17-1294.17），而 Narcan 为 73.62 美元（95%CI，69.24-78.00），通用纳洛酮为 67.99 美元（95%CI，61.42-74.56）。
在这项观察性研究中，研究结果表明，纳洛酮的自付费用一直是无保险患者获取纳洛酮的一个越来越大的障碍，这可能限制了这一人群的使用，而这一人群约占阿片类药物使用障碍的成年人的 20%。
