Availability and Cost of Naloxone Nasal Spray at Pharmacies in Philadelphia, Pennsylvania, 2017

Abstract

Key Points Question What is the availability of naloxone at pharmacies in Philadelphia, Pennsylvania, 3 years after the implementation of a statewide standing order in Pennsylvania allowing pharmacists to dispense naloxone without a prescription? Findings This survey study of 418 pharmacies in Philadelphia found that only one-third carried naloxone nasal spray and many also required a physician’s prescription, including pharmacies in communities with the highest rates of opioid overdose death. Meaning Efforts to strengthen the implementation of naloxone access laws and better ensure naloxone supply at local pharmacies are warranted, especially in localities with high rates of opioid overdose death.

Evaluation of naloxone access, pricing, and barriers to dispensing in Tennessee retail community pharmacies

“…35,36 For example, the maker of Evzio, dispensed by only 4 pharmacies in this study, was highly criticized by lawmakers in 2018 for charging more than $4000 per kit (which contains 2 doses); as a result of this criticism, the manufacturer announced plans for a $178 generic version to be released in 2019. 37 The average cash price of Narcan noted in this study ($132) was comparable to average out-of-pocket costs ($145) for naloxone nasal spray in pharmacies surveyed by Guadamuz et al 21 A previous survey of community pharmacists in North Carolina also identified cost and reimbursement issues as a barrier to dispensing naloxone. 38 Related to cost, lack of insurance coverage and issues with prior authorization were cited as barriers by approximately 45% and 21%, respectively, of the pharmacies we surveyed.…”

“…Lozo et al 20 found that only 31% of pharmacies in 10 New Jersey cities stocked naloxone. 20 Similarly, Guadamuz et al, 21 in a survey of pharmacies in Philadelphia, PA, after implementation of a statewide standing order, found that only 34.2% of surveyed pharmacies had naloxone in stock. 22 Another study of Pennsylvania pharmacies found that 45% of participating pharmacies stocked naloxone, and 55% did not, although 31% reported they could order the drug for pickup within a business day.…”

“…17,18 However, the barriers to naloxone access enumerated in the literature are concerning, and previously published studies have not explored naloxone access issues in Tennessee, although such issues have been examined in other states such as Texas, Pennsylvania, and New Jersey. [19][20][21][22]…”

Leveraging the role of community pharmacists in the prevention, surveillance, and treatment of opioid use disorders

“…Further, a non-trivial number of pharmacies provided erroneous information, such as recommending a buprenorphine–naloxone product not indicated to reverse overdose [39]. In another study, only a third of pharmacies in Philadelphia, where a state-wide naloxone standing order had been in place for more than 3 years, were able to provide nasal naloxone without a prescription [40]. A survey of community pharmacists in Indiana, where access laws are similar, found less than half of pharmacists were comfortable dispensing naloxone [41].…”

Addressing Obstacles to Evidence-Informed Pain Care

“…Co-prescribing naloxone with opioid medication is an accepted and encouraged practice for risk mitigation and can provide lifesaving overdose reversal. However, it is not always in stock in pharmacies 24 and misperceptions about naloxone are common. 25 Pharmacists in one study described being reticent to offer naloxone out of fear they would be viewed as accusing the patient of being a drug "abuser" and out of discomfort with how to discretely dispense it.…”