For quite some time, I have followed the news items about the national tragedy of opioid dependence in our country. It is estimated that on an annual basis, up to 60,000 people are dying of opioids and opioid-related incidents. In 2015 alone, more than 33,000 opioid deaths were reported.
It does not help that the very same medications that can cause dependency can also ease pain. Anyone who has undergone surgery can appreciate what a drug such as Percocet or OxyContin can do. The trouble is that certain patients can become addicted, and the addiction can be deadly. Some physicians have been guilty in the past as well, giving out opioids without properly monitoring patients.
Up until recently, there have been few options to wean patients off of opioid painkillers. A company called Alkermes has developed Vivitrol, a non-narcotic drug that works on a very comparable basis to opioids.
Patients on Vivitrol are given the medication by injection once a month. It apparently works by blocking the brain’s opioid receptors. It works very well. The drug was approved by the FDA in 2010 by the FDA to treat opioid detoxification. There are few competitors to this drug.
Vivitrol is priced at $1,000 per shot, but there is apparently a Opens a New Window. co-pay savings program “for eligible patients.” It is a safe drug, and estimates are that nearly 400,000 patients have already been treated with the drug.
Opioid Epidemic: The Ethical Debate
As I was reviewing the glowing reports of Vivitrol, I became struck, or perhaps confused by strange ethical dilemmas. On one hand, Vivitrol was approved by the FDA nearly eight years ago as an effective treatment to eliminate dependency on opioid painkillers. On the other hand, and depending on the source, up to 60,000 people a year in the United States alone could die as the result of opioid dependency, opioid related conditions and in accidents caused by people on opioids.
At first, I asked myself why Vivitrol was not administered as a matter of course by physicians who were even mildly suspicious of a drug dependency problem? Though the company tells us that nearly 400,000 have been successfully treated by the drug, over eight years, and being conservative in my estimates, more than 300,000 may have died of opioid dependency. There seems to be a lack of urgency in directing patients to this effective medication.
I realize that compared to Vivitrol, opioids are cheap. Sadly, some physicians have given them out like candy. I am also not naïve to the fact that opioids have become a street drug and addicts have embraced this street drug. Once hooked, their treatment options are sparse.
Vivitrol, at $12,000 per year, is not the kind of treatment that one would request without an incredible insurance policy. It leads to even more serious discussions. The first discussion is based on so-called co-pay programs and rebates. Friends and family members frequently report to me that the programs and rebates for any medication are neither long-term nor easily offered. The second discussion has to do with cost.
The co-pay program that Alkermes mentions reduces the cost of an injection from $1,000 to $500. That is quite a hefty savings. Though I am skeptical that the co-pay program will go “indefinitely,” I need to ask, “Just how much profit do you have built into each injection?” If Alkermes is willing to offer a hefty discount to encourage drug use, what does this product really cost to make?
A pharmaceutical company is a for-profit venture. They are not in business to be altruistic, they are accountable to shareholders and employees. Nevertheless, if they expanded the number of patients and healthcare institutions who could benefit from Vivitrol, could they not lower their price?
It almost appears as though Vivitrol is accessible only to those who can afford expensive policies or who are willing to devote a significant portion of their savings to kicking the habit. Suppose an addicted patient is of very modest means with a high deductible or basic policy? They are left to twist in the wind.
In order for fraud to occur, there must be an opportunity. Vivitrol has created a need because it offers a solution. The opportunity comes in charging whatever they feel the market will bear. In this case, the pricing – and the opportunity to be profitable, may be causing people to needlessly die where they could be helped.
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