An emergency opioid overdose kit is pictured. | AP Photo Price spikes for life-saving drug

The price of a life-saving drug that can reverse an opioid overdose is soaring, just as the Obama administration and Congress are pushing to make it more available.

The rising price for naloxone is causing some emergency response departments to run out of the drug, while many public health groups are growing short of the cash needed to buy it and must rely on donations. It also means two public health crises are colliding — the politically charged debate about high drug prices and the growing concern about lethal addiction.


Prices of some versions of the drug have risen as much as 17-fold in the past two years.

Naloxone, which has been on the market since 1971, is the latest old drug to have a big new price, part of a trend that’s angered Republicans and Democrats alike and has been condemned in congressional hearings. Democratic presidential candidate Sen. Bernie Sanders and Maryland Rep. Elijah Cummings opened a probe last year into Amphastar Pharmaceuticals, whose generic naloxone is the version most frequently used by emergency responders and in private homes when there is an overdose.

“Opioid abuse is an epidemic across our country, yet drug companies continue to rip off the American people by charging the highest prices in the world because they have no shame,” Sanders said in a statement Friday. “The greed of the pharmaceutical industry is killing Americans.”

The White House has stepped in, helping state and local governments combine their purchasing power to secure deeper discounts of the antidote, which works for both prescription opioids and street heroin. But complaints about soaring prices haven’t dropped off, just as public health officials are trying to make the drug more available in clinics, homes, and schools.

"You have increased demand and a few people who control the pricing, so they can charge whatever they want," said Eliza Wheeler, who runs the drug overdose prevention and education project for the Harm Reduction Coalition in Northern California.

More than 28,000 people died from opioid and heroin overdoses in 2014, more than any year on record, according to the Centers for Disease Control.

Congress is also focusing on addiction. The House passed a package of 18 bills last week aimed at tackling the opioid epidemic, and it will now go to conference with a Senate package (S. 524) passed in March.

With no new federal money attached to those bills, it’s unclear how many new opioid and heroin patients the antidote will reach or when. But House Appropriations Committee chairman Hal Rogers (R-Ky.) said lawmakers will be looking at the rising price of naloxone.

Rep. Patrick Meehan (R-Pa.) who wrote one of the opioid bills, concurred. “My suspicion is, there will eventually be efforts to hold down the cost,” he told POLITICO, adding that lawmakers had been focusing on access but should now also explore cost.

Drug companies blame the increases on manufacturing and packing costs, wholesalers and insurance company policies. New generic and branded competitors have entered the market but have had little impact on the price.

The price rise trajectory doesn’t fit the narrative the pharmaceutical industry has been putting forward, which portrays companies like Martin Shkreli’s former drugmaker Turing Pharmaceuticals as unique “bad actors” taking advantage of market failures. Shkreli's company raised the price of an AIDS drug.

Five versions of naloxone are now on the market — no failure there — and still, its price keeps rising.

The list price of Kaleo Pharma’s auto-inject version – specifically approved for a people without medical training to use in a life-threatening crisis — soared from $575 to $3,750 per two-dose package in just two years, according to Truven Health Analytics. Amphastar’s product cost $66 for two syringes at the end of 2014, nearly double the price a year earlier. Two vials of Hospira's generic, which cost $1.84 in 2005, shot up to $31.66 by 2014.

The price spikes are “not conscionable,” said Baltimore Health Commissioner Leana Wen, who has pushed for wider availability of the overdose antidote.

Generic versions of the drug cost pennies in other countries and could be had for under $1 in the U.S. not long ago. “We have not been able to understand what is motivating them except for profit,” Wen said.

A third generic naloxone, Mylan, entered the market in 2014, but that didn't reduce the drug's price. Another new drug, Adapt Pharma’s Narcan nasal spray, was approved in November, at a list price of $125 for two doses, with a "public interest price” of $75 for first responders and certain others.

“You would hope as we get more preparations they would get more competitive and start undercutting prices, but so far no dice,” said Sharon Stancliff, a medical director at the Harm Reduction Coalition.

The price increases have increased tension in the public health community. Limited government and private grant funding goes to help police, school nurses and emergency departments pay for naloxone, but community programs — which deliver naloxone, but also counseling and other services — are left out, Wheeler said.

Naloxone was first approved to reverse overdoses but also to diminish the impact of opioids given during surgery in hospitals. But as the opioid epidemic set in, outpatient use of naloxone has increased by 72 percent in the last five years, according to Food and Drug Administration data.

Generic drugmakers can’t legally sell naloxone for administration by first responders or non-medical professionals. That means that home-use versions have to be repackaged and marketed by a third party.

Amphastar, whose product is popular because it has been repackaged as a nasal spray, says these third parties are the ones jacking up the price. The company points to websites like BlowoutMedical.com, which sells naloxone kits for more than $130.

Insurers rarely pay for outpatient use of naloxone, and the groups that buy most of the drug lack clout to bargain with drugmakers. Many buying the drug pay for it out of pocket at a pharmacy.

The city of Baltimore, which gets its naloxone from medical supplier McKesson, pays $40 per dose of Amphastar, although its list price is $33. McKesson did not respond to requests to comment..

Some see the naloxone price hikes as part and parcel of the general trend. Hospira and Amphastar have raised the prices of many of their sterile injectable drugs in recent years, not just naloxone, says Wheeler of the Harm Reduction Coalition. Hospira has invested hundreds of millions of dollars to respond to FDA concerns about its manufacturing facilities. That may have influenced its pricing.

“Our actions have reflected sensitivity to the need for the product, and also take into account the reality and necessary investments needed to produce high-quality generic drugs,” said Rachel Hooper, a spokeswoman for Hospira, now owned by Pfizer.

Amphastar also says it has spent millions over the last two years to increase naloxone production. Cummings’ office says the company provided no documentation to support that claim.

Kaleo, on the other hand, says it raised prices of its naloxone product Evzio so it could afford to cover patient copays; insurers say this practice directs patients to pricier branded drugs, while raising everyone’s insurance costs.

“It’s not a solution that addresses the underlying issue, which is the price itself,” said America’s Health Insurance Plans spokeswoman Clare Krusing. “It shows that pharma is willing do to do anything to change the insurance model … so they don’t have to address the underlying price of the medications that they are charging.”

Before the company hiked naloxone prices this year, about two-thirds of Evzio prescriptions were never filled, said Kaleo spokesman Mark Herzog. Since the company started its patient access program in February — which is subsidized by new revenue generated by the price increase — filled prescriptions increased by 83 percent.

The drug in the auto injector is essentially the same as the older generic versions. About all that’s changed is the packaging, which includes voice-activated instructions.

“When I was little I had some dolls that talked,” said Carol Cunningham, medical director for the Ohio Department of Public Safety’s EMS division. “They didn’t cost $400.”

Brianna Ehley contributed to this report