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Experts slam plan to sell overdose antidote Narcan at about $50 a kit

Drugmaker’s retail price is ‘still too expensive for pretty much everyone I’ve ever provided it to,’ epidemiologist says

Narcan nasal spray. (Scott Olson/Getty Images)
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The nasal spray that reverses opioid overdoses will sell for “less than $50” per kit, the manufacturer announced Thursday, spurring criticism that the price of the over-the-counter medication would put it out of reach for many amid a drug crisis killing more than 100,000 people annually.

Drugmaker Emergent BioSolutions made the announcement weeks after the Food and Drug Administration approved Narcan for sale without a prescription, a long-expected shift designed to make the spray ubiquitous and easy to buy in chain pharmacies, supermarkets, convenience stores and gas stations.

But advocates have long worried that the price of Narcan — a 4-milligram spray version of the liquid drug naloxone that comes two to a kit — might be a barrier for those who need it the most.

“It’s still too expensive for pretty much everyone I’ve ever provided it to — mainly teens and people experiencing homelessness,” said Chelsea Shover, a professor of epidemiology at UCLA. “That price point is probably fine for many businesses or organizations who want or have to have a Narcan kit or two publicly available.”

Emergent said its kits will be on store shelves, and available for purchase online, by late summer. In a statement Thursday, the company said it needs to “foster a sustainable business model” and is taking a “responsible approach to pricing” that includes the costs of manufacturing, packaging and shipping.

The company did not cite an exact price. But while individual retailers ultimately decide how much to charge per Narcan kit, the company also said its “goal” is for the retail price to be “consistent with our public interest price.” The company has charged about $47 to local and state health departments, harm-reduction groups and first responders who have handed out millions of doses of naloxone in recent years.

The president of the National Council for Mental Wellbeing said a price near $50 is “too high for the average person,” especially because some overdose victims may require multiple doses of the spray.

“I think the price needs to be under $10 per dose,” Chuck Ingoglia, the council’s president and CEO, said in a statement.

Naloxone, which replaces opioids binding to receptors in the brain, is not habit-forming and is safe to use on people who are not overdosing. It was long a prescription drug, but most states now use a “standing order” system of blanket prescriptions to allow customers to purchase the drug at a pharmacy, and for harm-reduction groups to dispense kits to drug users on the street and even by mail.

Liquid naloxone, which must be injected, is far cheaper but has not been approved for over-the-counter sales. Remedy Alliance, an umbrella organization that sells liquid naloxone to harm-reduction groups and has shipped more than 768,000 vials since last fall, purchases two-vial kits for less than $4 each.

“Many people prefer it, yet we haven’t seen the same push to make it as readily available,” said Ryan McNeil, professor of public health and medicine at Yale University. “It needs to be. Frankly, it’s cheaper to access.”

Despite the higher prices, Narcan’s ease of use has made it more mainstream in recent years as the opioid crisis has raged, with fentanyl killing about 70,000 people in 2021. This week, following the FDA’s decision to make Narcan available over the counter, the Arlington County school system in Virginia announced it would allow students to carry the spray on campus.

Narcan’s prices have steadily declined — a couple of years ago, the public interest price was $75 per two-dose kit, which has come down to about $47. In the past, people without health insurance had paid well over $100 using blanket prescriptions, according to studies by researchers at the University of Texas at Austin’s College of Pharmacy.

“Fifty dollars is probably not accessible for everybody, but I like that price more than the $130 we were seeing before,” said Kirk Evoy, a clinical associate professor at UT, adding that he would like to see the price continue to drop.

Prices could also come down if the FDA approves generic over-the-counter versions of the Narcan nasal spray.

For now, though, the $50 price point will make it harder to “massively scale up distribution” of naloxone, said Sarah Evans, division director of drug policy for Open Society Foundations, a grant-making network. “We’re not going to make a dent in the overdose crisis,” Evans said.

Emergent, of Gaithersburg, Md., has insisted it is committed to maintaining affordability. It has also called on Congress to ensure that private and government health insurers cover Narcan now that it is available over the counter.

“It is critical that we come together with government leaders, retailers and other key stakeholders to ensure efforts are focused on increasing awareness, broadening access, and helping to maintain affordability,” the company wrote Thursday to Sen. Richard Blumenthal (D-Conn.), who has pushed for affordable retail Narcan.

The American Medical Association has said it hopes retail Narcan is covered by insurance plans at little or no cost to consumers.

“There are many over-the-counter preventive health medications that are covered by insurance, such as aspirin, vitamin D and fluoride,” Bobby Mukkamala, chair of the group’s substance use and pain care task force, said after the FDA’s decision last month. “Naloxone should be added to that list.”