Price hike drives IV Acetaminophen out of reach for emergency medicine – right where it is needed most.
Recently I wrote a column extolling the benefits of IV acetaminophen and asking why more emergency clinicians weren’t using the drug. On the face of it, the arguments for its use were pretty straightforward – no opiate sedation or nausea and the potential for less opiates to be used (or omitted entirely).
To my mind there were only two reasons that IV acetaminophen wasn’t being used – physicians weren’t aware of the product and its potential value (the reason for my column) and the potential price tag. When first released, the drug was $13 a gram. Those comparing the costs of IV acetaminophen vs IV opiates (perhaps $1) had what appeared to be a good case for not using the drug (or using it sparingly and for specific indications). My position, however, was that given the cost of an average ED visit exceeds an embarrassing $1,200, the price difference between the drugs was inconsequential.
However, my initial information on the price of the drug turned out to be incorrect.
Now I find out that the manufacturer of the drug has decided to take away any rational reason to use the drug. As with other seemingly absurd increases in the cost of drugs that have been reported recently, the powers that be have decided to raise the price of IV acetaminophen from a ridiculous $13 to $35.
Paradoxically, the ED would be the ideal environment to push the use of this drug. Lots and lots of people present with pain and, except for IV ketololac, which has many issues of its own, the ability to be able to give a reasonable alternative analgesic to opiates is very appealing.
Not any more. It seems the manufacturer, as a result of its actions, has decided to effectively kill the use of their drug. At $35 a dose, nobody is going to use it in the ED and hospital pharmacy committees are going to sharply restrict the use of the IV version of the drug to the point of extinction. As well they should.
My apologies for any confusion my column may have caused. I will work to keep any future drug recommendations up to date with current pricing. Thanks for reading.
5 Comments
Oh, how I sense the frustration of Dr Bukata. I share his frustration.
Very sad.
After reading and applauding Dr. Richard Bukata’s ini- tial column on the virtues of IV APAP in the ED, I was rather perplexed by his about face in his follow up col- umn on December 3rd based solely on a $22 misun- derstanding on the cost of the drug.
With all due respect, this seems a bit off the mark and short sighted in the least. As Dr. Bukata points out, the cost of goods and services for an ED visit, and then figuring out what is billed, is a perplexing and mind numbing exercise. Although the “shelf price” of a 1 gm dose of IV APAP may be listed at $35, the actual price the hospital pays and what they charge for it varies dramatically based on location and volume. When look- ing at a $194 charge to start an IV, $28 for zofran 4 mg IVP, $85 for 1 gm of Rocephin, etc, it seems silly to dis- regard all the clinical benefits pointed out initially be- cause of a twenty spot; but if one wants to venture down that dark road of costs (he did it, not me!), we need to point out the significant cost savings gained by
December 20, 2015
the more liberal use of this non-narcotic pain medica- tion.
•DecreaseLOSleadingtobetterEDthroughput. As Dr. Bukata mentions, using IV APAP often obviates the need for narcotics at all, or at least shaves 40 –
60 min off ED LOS when you don’t have to give that 2nd or 3rd dose of narcotics. Use it enough, and that will add up to less time on Bypass and better patient satisfaction scores. (The hospital loves you, and since our reimbursement is soon to be tied to patient sat scores, your group does, too.)
• Significant proven decrease in hospital days for ad- mitted hip fractures if given early and peri-operatively: Cha…ching!!!
• Decreasing extra resources and potential litigation for those 1-2 elderly patients per quarter who have a near miss after being over sedated on even low doses of opiates. This is a JCAHO hot button item right now and goes for obese patients prone to obstructive sleep apnea as well.
• Letting countless patients drive their own car home af- ter diagnosing and treating them for renal colic, diver- ticulitis, extremity fractures, rib fractures, etc when us- ing IV APAP with or without tordol. Where I practice, $22 doesn’t get you far by cab or uber. What is your hospital paying in cab vouchers?
• The savvy administrators get this when given all the data on the big picture; then they negotiate a good price for the drug, and immediately start stocking in the ED.
So it works great, our patients love it, very few side ef- fects or precautions, the hospital benefits, and our pa- tients are safer. I can think of a worse way to spend $22.
My approach will be to leave the line item cost con- cerns to the bean counters and return to the enthusi- asm and vigor embraced in Rick’s October 15th column calling for the increased use of IV APAP in the ED, backed by multiple studies. In this day and age of over- prescribed narcotics, advocating for our patients to provide an efficacious alternative to opiates, with fewer side effects is…well…priceless.
Andrew P. Desjardins, MD
Dr. Desjardins can be reached at 7901 Frost Street, San Diego, CA 92123 or a.desjardins@roadrunner.com
The author has no relevant financial disclosures
I find it interesting that Andrew P. Desjardins, MD, when in fact, he is a paid consultant for Ofirmev.
I was charged $450 for a 1 gram dose of Ofirmev after abdominal hysterectomy surgery. I was infused 3 times with this medicine (total cost $450*3= $1350). WHY????