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When Cost Sharing Increases, More Naloxone Prescriptions Go Unfilled
When cost sharing increased due to insurance deductible resets at the beginning of the year, the percentage of naloxone prescriptions abandoned at US pharmacies increased, according to study results published in JAMA.
“The elimination of cost sharing might be associated with increased naloxone dispensing to commercially insured and Medicare patients,” wrote corresponding author Kao-Ping Chua, MD, PhD, of the University of Michigan Medical School, in Ann Arbor, Michigan, and study coauthors.
The cross-sectional analysis included 73,311 naloxone claims for commercially insured patients and 106,076 naloxone claims for Medicare patients from a national pharmacy transactions database. A regression discontinuity approach exploited the fact that insurance deductibles typically reset in January. Researchers looked specifically at dispensed and undispensed (abandoned) claims for naloxone nasal spray that occurred 60 days before, and 59 days after, January 1, 2021.
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The average cost sharing per naloxone claim increased by $15.0 for patients with commercial insurance and $12.3 for patients with Medicare on January 1, 2021, according to the study. Meanwhile, the probability of abandonment in the new year also increased for both groups: by 4.7 percentage points for patients with commercial insurance and 2.8 percentage points for patients with Medicare.
Estimates suggested a $10 increase in naloxone cost sharing would be associated with a 3.1-percentage-point increase in the probability of abandonment for commercially insured patients and a 2.3-percentage-point increase in the probability of abandonment for Medicare patients, researchers reported.
“[A]n over-the-counter formulation of naloxone nasal spray became available in September 2023 with a price of $45 per 2-pack,” the authors noted. “This study focuses on insured patients and does not specifically address whether decisions on purchasing over-the-counter naloxone are associated with price. Despite this caveat, the study’s findings may provide indirect evidence that lowering the price of over-the-counter naloxone could be associated with increased use.”
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