Over the counter Narcan is here, although will not be covered by most health plans

September 11, 2023

There were over 100,000 deaths from drug overdoses in 2022, and many of these deaths were opioid overdoses.  Naloxone, a drug which reverses the effects of opioids, can save lives -but it’s often not available when people overdose.

Naloxone is available by prescription currently as: Narcan injection (and generic equivalent), in (expensive) auto-injectors and as a nasal spray. An over-the-counter nasal spray will be available this month. That’s great news, as we want to eliminate barriers to saving people’s lives.  I wrote a note earlier this year about why employers should consider putting Narcan in first aid kits at the workplace.

The manufacturer has announced a recommended price of $45, which is similar to the price of prescription naloxone nasal spray.  In most states, people can go to a pharmacy without a prescription to obtain naloxone as pharmacists have a standing order from the state Department of Public Health.

Coverage is tricky. Prescribed naloxone is generally covered subject to deductibles and coinsurance. Employers with tax advantaged Health Savings Accounts cannot cover naloxone without cost sharing, as this is not on the Internal Revenue Service preventive medication list.

As of now, the major PBMs do not have a process in place to reimburse for purchase of OTC naloxone, and if they do put this in place it could well require a prescription.

Implications for employers:

-        Monitor to see if pharmacy benefit managers develop a program to cover OTC Narcan and be certain that costs paid are reasonable.

-        Check with counsel about any plans to offer coverage pre-deductible in the presence of a high deductible health plan with associated health savings account.

-        Consider including naloxone in first aid kits available in the workplace.

Tomorrow: COVID-19 update

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