Could Aetna’s $0 Copay For Narcan Save Lives?

Payers are grappling with their responses to the opioid crisis. Support for their moves isn’t unanimous.

One of the largest health insurance companies in the U.S. announced new steps Tuesday to combat the opioid epidemic by imposing stricter prescription limits and waiving copays for the overdose-reversing nasal spray Narcan.

Aetna says the changes, which will take effect on New Year’s Day, will remove financial hurdles that currently keep some Americans from accessing and using the life-saving drug.

“Cost is clearly a factor in whether individuals with substance abuse disorder obtain medication that could save them from a fatal overdose,” Harold L. Paz, MD, MS, executive vice president and CMO for Aetna, said Tuesday in a statement. “By eliminating this barrier, we hope to keep our members safe until they are ready to address their addiction.”

Members currently make copayments ranging from $0 to $150 for Narcan, with the average typically landing between $30 and $40, the company says. Those with higher copays have been less likely to fill their Narcan prescriptions.

During the first six months of the year, more than three-quarters (76.7%) of Aetna members with copays above $100 for Narcan didn’t pick up their prescriptions, the company says, citing claims data from IMS Health. This abandonment rate was much lower (46.1%) for Aetna members with copays between $40.01 and $50.

A company spokesperson tells HealthLeaders Media the copay waiver will apply to Aetna’s 4.6 million fully-insured commercial members. That excludes about 13.5 million self-insured medical members, whose copay structure will continue to reflect the current ranges unless and until their self-insured employers decide to incorporate the Narcan copay waiver into their benefits plans, the spokesperson says.

Thom Duddy, spokesperson for Narcan manufacturer ADAPT Pharma, says the company’s pricing model has been transparent and consistent since its launch last year.

“We’ve never raised our price,” Duddy says.

Across all payers, more than a third of prescriptions for the nasal spray already enjoy a $0 copay, according to the company. Nearly 80% of the prescriptions have a copay of $20 or less.

Praise & Criticism

Leo Beletsky, JD, MPH, an associate professor of law and health sciences at Northeastern University in Boston, praises Aetna’s effort to make naloxone (the active drug in Narcan) more affordable.

“It is unconscionable that in the middle of a public health emergency, we still have numerous barriers to accessing this lifesaving medication,” Beletsky writes in an email.

Beletsky is less than pleased, however, by the other initiative Aetna announced Tuesday. The company says it will limit opioid prescriptions to a seven-day supply for its 8 million commercial pharmacy members, when members experience acute pain or recover from surgery—a move Beletsky says could do more harm than good.

“Research suggests that needs for post-operative opioid use are highly varied, depending on the procedure and the patient. Those modal needs vary from 3 to 14 days,” Beletsky writes. “I agree that we need to moderate opioid prescribing to align it more closely with what is necessary and appropriate, but across-the-board mandates and limitations of this sort are not driven by evidence and can be counterproductive.”

For its part, Aetna says its seven-day limit is based on research by the Centers for Disease Control and Prevention (CDC) that found 13.5% of patients who received an opioid prescription for eight days or more were still taking the painkillers one year later. (The figure is 30% for patients who receive opioid prescriptions for 30 days or more.)

What’s more, the Pharmaceutical Research and Manufacturers of America (PhRMA) announced its own multi-year initiative Tuesday to tackle the opioids problem in partnership with the Addiction Policy Forum. PhRMA’s expanded policy proposals call for seven-day supply limits on opioid prescriptions for acute pain, with exceptions.

That seven-day initial limit is already law in New York, where Gov. Andrew Cuomo signed a measure last year.

‘Long-Lasting Solutions’

Earlier this year, at least two large pharmacy benefit managers (PBMs), CVS Health and Express Scripts, announced coverage limits of their own on new pain pill prescriptions. The moves have come amid public pressure for payers to take some degree of responsibility for the future of the opioid crisis if not its past, as ProPublica reported.

The nation’s four other major national health insurers reportedly didn’t respond to Axios when asked whether they would follow Aetna’s lead.

In 2015, more than 63% of the record 52,404 drug-overdose deaths tracked by the CDC involved opioids. The number of drug deaths rose to more than 64,000 last year.

“The challenge in front of us requires that everyone be at the table, working together to implement comprehensive, long-lasting solutions that will save lives,” said Addiction Policy Forum President and CEO Jessica Hulsey Nickel in a statement. “We look forward to partnering with leaders in the biopharmaceutical community to help states, cities, towns and families change the trajectory of this crisis.”