Generic opioids are cheap. Alternative drugs, not so much

The opioid abuse epidemic is a thicket rooted in a field full of social problems, regulatory shortfalls and healthcare system problems. But one of the challenges of adopting alternative painkillers is a common one: Price.

Opioids are obviously addictive. They’re also available as cheap generics. But the latest non-opioid painkillers aren’t--and they’re expensive, as the best-practices firm Advisory Board tells us.

Consider Mallinckrodt’s intravenous form of acetaminophen, Ofirmev. It’s used by some hospitals as an inpatient alternative to opioids. It’s also $35 per dose, with most people requiring four doses. Vicodin, by contrast, is available for $5 per prescription.

There’s also Exparel, a non-narcotic anesthetic injected during surgery, also used as an opioid substitute. It’s even pricier than Ofirmev at $300 per dose.

"The problem with any of these alternatives that we're seeing: There's a cost associated with them," Lowell General Hospital’s chief of orthopedics, Dr. Scott Sigman, told Advisory Board.

Older meds such as the anti-inflammatory ibuprofen or oral acetaminophen, aka Tylenol, will also knock out pain if used at high enough dosages, doctors told the firm, but at those doses they can trigger long-term health problems. Acetaminophen, for instance, has been linked to liver damage over the long run, and non-steroidal anti-inflammatories such as ibuprofen were recently tagged with heart risks after long-term use.

Meanwhile, the FDA has been piling on new guidelines and warnings about the use and abuse of opioids. In March, the agency set new limits on use of immediate-release opioids. Because of addiction dangers that come with oxycodone, hydrocodone and morphine, the FDA is mandating new labels to stipulate that immediate-release versions should only be given for severe pain when nonaddictive drugs are not enough. Most opioid prescriptions these days are for immediate-release forms of the drugs.

Meanwhile, new Centers for Disease Control and Prevention guidelines are calling for big cuts in opioid use.

Some drugmakers, to counter criticisms about profiting off addiction, have rolled out awareness campaigns to highlight the dangers of opioid abuse. Teva Pharmaceutical Industries, for instance, launched a video series that uses absurd humor to highlight scenarios where people are struggling with opioid addiction. 

Other pharmas have seen a financial opportunity in the opioid-addiction market. Alkermes sells Vivitrol, now approved to treat opioid abuse, and its sales mushroomed by 53% last year to $144 million. And a variety of antioverdose formulas based on the drug naloxone are being adopted by law enforcement agencies and emergency medical teams nationwide. The makers of those meds, including Amphastar Pharmaceuticals, have drawn fire--and lawsuits filed by state attorneys general--for instituting big price increases as demand for their products grew.

- see the Advisory Board post

Related Articles:
FDA sets new limits on use of immediate-release opioids
CDC guidelines call for drastic cuts in opioid painkiller use
Senate committee takes Pfizer, Mylan and others to task over naloxone price increases
Teva goes for the absurd in latest opioid addiction video series
Alkermes gets big revenue boost from dark side of opioid use
Amphastar pays some rebates after price of overdose drug doubles