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Why aren't more people obtaining naloxone kits?

Dr. Rachel Levine’s heart is certainly in the right place.

Levine, Pennsylvania’s physician general, staged a media event Thursday drawing attention to the ongoing epidemic of drug overdose deaths statewide.

Levine and other government officials went to an Adams County pharmacy to demonstrate how easy it is to fill a prescription for naloxone, the life-saving drug that reverses opioid overdoses.

Under a standing order signed last year by Levine, any Pennsylvania resident can get naloxone, better known by its brand name Narcan, from any pharmacy. No questions asked.

In theory, that sounds like a noble thing to do. Any compassionate individual who is able should be prepared to help a neighbor in distress — and who could be more distressed than an addict in the throes of an overdose of heroin, a prescription opioid or a synthetic drug like fentanyl?

“The disease of addiction can develop in anyone who uses opioids, including military veterans and older Pennsylvanians who use pain medication to manage chronic pain,” Levine said in a prepared statement. “Addiction is not a moral failing, and any person who suffers an overdose deserves another chance at life. Obtaining naloxone using my standing order and knowing how to administer it can save the life of a loved one or a member of your community.”

However, there is one flaw in the order that prevents its widespread use.

Medical insurance doesn’t cover the cost of Narcan unless it’s to be used by the insured individual. In other words, getting naloxone is an admission to your insurer that you have an opioid addiction.

You might ask, so what? Under current law that’s considered protected health information and nobody’s business but your own.

True. It is considered protected health information, or PHI, under the federal Health Insurance Portability and Accountability Act — HIPAA.

But HIPAA does not apply to your medical insurance carrier, and if you require surgery or get injured later and need a strong pain medication, your insurer is likely to deny it — because you bought Narcan, remember?

You could lie and say it’s for the 21-year-old son or daughter still on your insurance. But if it is not for your child, that would be fraud and you are breaking the law.

An additional observation that might matter to some prospective buyers of naloxone: While a new statewide registry keeps track of every opioid prescription filled in Pennsylvania, naloxone prescriptions are not tracked in the registry. Information about who is getting naloxone is not shared with any state or federal agency.

And it bears repeating, the information is shared with your insurance carrier if you ask the insurer to pay for the naloxone.

The price of Narcan has jumped in recent months. A twin pack of 4-milligram single doses of Narcan nasal spray currently sells for about $140. Fifteen years ago, a single injection of naloxone was available for less than a dollar.

The pharmaceutical industry — the naloxone industry in particular — defends the cost, saying it’s a bargain when considering the alternative. By their estimates, a single fatal overdose costs the public $30,000 or more.

We’re not sold on the $30,000 estimate, but just for the sake of argument let’s consider: The coroner’s most recent count is 68 overdose deaths in Butler County during 2016, with the cause of death still pending for seven fatalities. Multiply the 68 deaths by $30,000 to get the estimated cost of $2.04 million.

If Narcan constitutes a proverbial ounce of prevention, then the question must be asked: what’s that ounce of prevention worth? And who’s willing to pay for it?

There is no easy answer. And so the tough questions will persist.

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