then it’s not going to help, and it’s not going to be available to help.” One key question, he says, is how
insurance companies will handle naloxone as it becomes more avail- able and more expensive. Medicaid in Texas does cover all formulations of naloxone, which is on the program’s preferred drug list. Kaléo’s website, www.kaleopharma
.com, says it has enhanced its patient access program to minimize out-of- pocket costs for Evzio, adding that commercially insured patients can usually obtain the drug with no out- of-pocket charge, even if their plan doesn’t cover it. “Today, a physician can prescribe
any of the three formulations of nal- oxone,” Dr. Tirado said. “What a pa- tient can actually get covered entirely hinges on their pharmacy benefit plan. “In the total range of costs that
health plans pay for medication, even with the price increase of naloxone, it’s still within a reasonably priced range when you compare it to other high-cost pharmaceuticals, for in- stance. However, the price has certain- ly gone up quite a bit, and health plans, regulators, and consumers should cer- tainly demand that the price of this medication does not become inflated. There is too much at stake for people not to have access to this medication.” Mr. Kinzly says the higher prices
remove the ability for TONI to get nal- oxone into the parts of the community that cannot afford it. He says TONI has “probably distributed $300,000 to $400,000 worth of naloxone in the state of Texas free of charge to the citi- zens,” but won’t be able to continue to do so because of the increasing costs. “We were getting it very cheap with
the ability to distribute it throughout the state,” he said. “We gave it to all people that we train, we were able to get it to organizations that work with high-risk individuals, and that’s all going to go away because people can’t afford it.” He says TONI looks for alternative routes to obtain and distribute nalox-
one, including reaching out to philan- thropists and working with pharma- ceutical companies to improve access.
AWARENESS AND STIGMA Austin obstetrician-gynecologist Kim Carter, MD, a member of TMA’s Task Force on Behavioral Health work- group on opioid overdose prevention, says the death of pop star Prince in April has helped raise awareness of prescription painkiller abuse. Health officials in Minnesota announced Prince died from an overdose of the synthetic opioid Fentanyl. One week before Prince died, first responders reportedly revived the singer with a shot of Narcan after he lost conscious- ness on a plane, which made an emer- gency landing. “I think it’s been very helpful to use
him as an example because he com- pletely passed out without being som- nolent before he passed out, which is exactly what happens,” Dr. Carter said.
“You don’t get sleepy and appear drunk with some of these meds. You just quit breathing.” Even as awareness may increase,
stigmatization of drug addicts remains a potential barrier. Dr. Tirado says that stigma is “clearly one of the hope- fully last great hurdles that we have to overcome” in treating chronic ad- diction. He says medicine has largely accepted that addictions are disorders with a biological basis much like other chronic diseases, even if some say that science isn’t settled. “The medical community by and
large understands that this disorder is more than just having a weak will or being an unfit or delinquent person or a person fundamentally lacking in moral character,” Dr. Tirado said. “As more good research on the neuro- biology of addiction comes out, and as more pharmacotherapies for ad- diction come out, we’re going to see even more awareness and acceptance of the fact that addiction, if we’re re- ally going to deal with it effectively in our culture, is better addressed as a chronic relapsing condition, as a pub-
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September 2016 TEXAS MEDICINE 53
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