The next big controversy about a medication markup just hit the United States. This time, the makers of an auto-injector used to deliver the drug naloxone, a lifesaving antidote that helps reverse opioid overdoses, hiked the price of the device by more than 500 percent during the last three years, Scientific American reports

The company responsible is a small Virginia firm called Kaleo, which makes a naloxone injector called Evzio. In the wake of the nation’s ongoing heroin and prescription painkiller epidemic, demand for the product grew. In addition, financial records showed that since 2014 the firm raised the price for a twin-pack of the device from $690 to $4,500.

Like Mylan, the company that boosted the price of its Epi-Pen to $600 for a twin-pack, Kaleo reaped huge profits from an auto-injector that delivers a relatively inexpensive medicine. Currently, a 10-millileter vial of generic naloxone—on the market since 1971—costs around $150. The cost of generic naloxone more than doubled during the last few years, but that’s still less than the 500-percent-plus increase Kaleo charged state and community health organizations across the country.

Admittedly, Evzio, which was approved by the FDA in 2014, is more than just a shot. The device talks users through the process as they inject naloxone. This feature allows anyone—even an untrained person—to correctly administer the medication to someone who has overdosed  and potentially save his or her life, stressed Kaleo. 

Still, advocates said the device’s surge price is way out of step with production costs and is a needless drain on the nation’s health care resources. “I might have 10,000 to spend on naloxone for a year, to supply a whole city,” said Eliza Wheeler of San Francisco’s Harm Reduction Coalition in a recent interview about the price hike. “If I have 10 grand to spend, I certainly can’t buy two Evzios.”

Kaleo tried to blunt the backlash over its price increase by dispensing the device to cities and state health departments for free. In addition, the firm offers coupons for the device to patients with private insurance, so there’s no copay when they pick up the device. The company also stresses its willingness to negotiate discounts for Evzio with organizations such as the Veterans Health Administration.

But advocates counter that even with subsidies the company offers to offset higher costs for Evzio, these programs still push up patients’ insurance premiums. The price increase may also affect access to the device by businesses, such as fast food restaurants, grocery stores and other retail establishments in neighborhoods where overdose is common.

Click here to learn more about naloxone and how the drug works to help reverse opioid overdoses.