Narcan's road to store shelves this summer

The ideas and innovators shaping health care

Mar 31, 2023 View in browser   By Ben Leonard, Erin Schumaker and Carmen Paun WEEKEND READ A prescription for a Narcan two-pack, administered like an allergy nasal spray, retails for about $70. | Scott Olson/Getty Images The Food Drug Administration's decision this week to allow Narcan, the opioid overdose reversal medication, to be sold without a prescription is a win for the Biden administration — if the drug is sold at a low enough price. While Emergent BioSolutions, Narcan’s manufacturer, has not yet disclosed an over-the-counter price for the drug, public health experts told POLITICO’s Katherine Ellen Foley that if the price is too high, people most at risk for opioid overdoses won't be able to afford it. A prescription for a Narcan two-pack, administered like an allergy nasal spray, retails for about $70. The drug quickly reverses opioid overdoses and doesn’t cause adverse effects if administered to a person who hasn’t consumed opioids. Although consumer costs vary, many insurance companies don’t cover over-the-counter drugs. HHS Secretary Xavier Becerra celebrated the decision as a victory in a statement, calling it “another strong step forward” to provide “expanded access to more life-saving naloxone in communities across the country.” Others were more skeptical, including Nabarun Dasgupta, an innovation fellow at UNC Chapel Hill’s public health school and board chair of the Remedy Alliance, a nonprofit that distributes free naloxone. “What we know from public health experience is the price of the antidote needs to be cheaper than the price of the dope,” Dasgupta told Katherine. “Until the price is less than a bag of fentanyl and heroin, the idea that someone will buy this off the shelves is effectively a pipe dream.” To that point, people who inject or inhale drugs are more likely to use the injection form of naloxone instead of the Narcan nasal spray formula, partly because it’s often free at needle exchanges and other harm-reduction sites. Harm Reduction Therapeutics, a competitor backed by opioid manufacturer Purdue Pharma, has a rival product awaiting FDA approval. Its naloxone spray, RiVive, would cost about $36 for a two-pack — about half of Narcan’s current cost. Big picture: The U.S. drug overdose crisis worsened during Biden’s administration, with opioid overdose deaths reaching 81,000 in 2021, up 20 percent from the previous year. WELCOME TO FUTURE PULSE Erin Schumaker | Lake George, N.Y. This is where we explore the ideas and innovators shaping health care. This week, the Senate special committee on aging took a look at guardianships, prompted in part by Britney Spears' emancipation from her “abusive” guardianship in 2021. Pennsylvania Democratic Sens. Bob Casey and John Fetterman used the hearing to introduce the Guardianship Bill of Rights Act, which would create a council charged with developing less constricting guardianships for the 1.3 million people with disabilities in these arrangements. Could the #FreeBritney movement be bigger than Britney? Let us know. Today on our Pulse Check podcast, host Megan Messerly talks with Alice Miranda Ollstein about the proposals that some Republican governors and lawmakers in staunchly conservative states have referred to as a “new pro-life agenda” for the post-Roe era — promoting sex education, government welfare and more birth control. Share any thoughts, news, tips and feedback with Ben Leonard at bleonard@politico.com, Ruth Reader at rreader@politico.com, Carmen Paun at cpaun@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Listen to today’s Pulse Check podcast   JOIN POLITICO ON 4/5 FOR THE 2023 RECAST POWER LIST: America’s demographics and power dynamics are changing — and POLITICO is recasting how it covers the intersection of race, identity, politics and policy. Join us for a conversation on the themes of the 2023 Recast Power List that will examine America’s decision-making tables, who gets to sit at them, and the challenges that still need to be addressed. REGISTER HERE.     DATA DIVE An Adderall shortage has led to many patients struggling to fill scripts for months. | Jenny Kane/AP Photo After relatively slow growth between 2010 and 2019, attention-deficit hyperactivity disorder diagnoses have surged since 2020, according to new data released by Epic Research. In 2010, the percentage of patients diagnosed with ADHD in Epic’s database of more than 183 million patients was 0.19 percent. That figure jumped to 0.57 percent by 2022. During that time, the share of patients with ADHD who were prescribed stimulants like Adderall stayed mostly level, but the share of patients with ADHD diagnoses tripled. “These findings suggest that an increase in the number of stimulant medication prescriptions is likely driven by the increase in new ADHD diagnoses, rather than new prescriptions for those who have previously been diagnosed with ADHD,” Epic wrote in its report. Why it matters: The findings come amid an Adderall shortage that has led to many patients struggling to fill scripts for months and scrutiny on telemedicine prescribing of the drug. The Drug Enforcement Administration has proposed tightening pandemic-era regulations that allowed doctors to prescribe Adderall without an in-person visit. The agency proposes that patients must visit their health care provider in person to obtain a prescription. Telemedicine and mental health advocates have pushed back against the proposal, saying it would limit access to care. But the DEA has said the in-person requirement could help prevent prescribing without sufficient oversight. The DEA has launched investigations of telehealth companies Cerebral and Done after they allegedly overprescribed ADHD medications under the relaxed pandemic rules. Those companies deny wrongdoing. An Epic spokesperson said the data doesn’t include information from Cerebral and Done. More details: Kids between 6 and 11 were the most likely to be diagnosed with ADHD. Males are still more likely to be diagnosed with the condition than females but the gap is closing. Males were 133 percent more likely to get an ADHD diagnosis than females in 2010 and 28 percent more likely in 2022.   LISTEN TO POLITICO'S ENERGY PODCAST: Check out our daily five-minute brief on the latest energy and environmental politics and policy news. Don't miss out on the must-know stories, candid insights, and analysis from POLITICO's energy team. Listen today.       Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun Erin Schumaker @erinlschumaker   Follow us

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