A brand new examine discovered that the majority plans in 40 states and Washington, DC coated a minimum of one type of the opioid overdose reversal drug naloxone, though sure restrictions and amount limits should still forestall individuals from accessing this life-saving drug.
In 2023, the US Meals and Drug Administration authorized the overdose reversal drug naloxone, generally generally known as Narcan, for over-the-counter (OTC) use. Whereas hailed as a public well being success for rising entry to this life-saving drug, this OTC choice stays out of attain for individuals who can not afford the $45 common price ticket for a two-dose field.
Medicaid recipients are a low-income inhabitants that disproportionately experiences opioid overdoses, so entry to low- or no-cost naloxone by insurance coverage can assist to avoid wasting lives. A brand new examine led by Boston College College of Public Well being (BUSPH) investigated Medicaid managed care plan protection of naloxone throughout the nation.
Revealed in JAMA Community Open, the examine discovered that the majority Medicaid managed care plans (MCPs) cowl a minimum of one of many 4 formulations of naloxone. Eighty % of Medicaid recipients, which embody greater than 70 million individuals, are enrolled in these plans. The examine is the primary to evaluate naloxone protection inside MCPs.
“These findings are necessary as a result of over-the-counter naloxone can nonetheless be very costly and insurance coverage protection can cut back the price barrier to accessing this drug,” says examine lead and corresponding creator Sage Feltus, analysis affiliate within the Division of Well being Regulation, Coverage & Administration (HLPM) at BUSPH. “The overdose dying charge amongst Medicaid beneficiaries is twice as excessive because the overdose charge among the many normal US inhabitants. Low-barrier and low-cost naloxone might assist get this important medicine into the palms of people who find themselves at excessive threat for overdose dying.”
The examine’s senior creator is Dr. Maureen Stewart, analysis affiliate professor in HLPM at BUSPH, and co-authors embody Dr. Jeffrey Bratberg, scientific professor at The College of Rhode Island Faculty of Pharmacy, and Sophia Balkovski, a doctoral trainee on the Heller College for Social Coverage and Administration at Brandeis College.
After rising sharply through the COVID-19 pandemic, drug overdose deaths involving opioids declined to 83,140 in 2023, adopted by a big drop to 54,743 deaths in 2024, in response to provisional knowledge from the Facilities for Illness Management and Prevention.
Naloxone, which is taken into account the cornerstone of the harm-reduction method to the nation’s opioid overdose emergency, can rapidly reverse the consequences of opioids similar to heroin, oxycodone, and fentanyl. Consultants have lengthy sought to extend consciousness of and entry to this medicine to securely and successfully cut back deaths from opioid use.
For the examine, the researchers reviewed the popular drug lists from 264 MCPs that coated 65.3 million Medicaid recipients in 40 states and Washington, DC. Insurance coverage firms and states can use these most well-liked drug lists to barter rebates with drug producers. The crew examined MCP reported protection and administration of all accessible formulations of naloxone: model and generic 4-mg nasal sprays; a generic injectable; and a more moderen, high-dose, model nasal spray in 8 mg. In addition they reviewed publicly accessible knowledge on state-level opioid overdose deaths.
Whereas amount limits and different restrictions diverse by plan, 94% of plans reported masking a minimum of one generic injectable or 4-mg generic/model variations of the nasal spray of naloxone, and 91% coated the 4-mg generic or model nasal spray and injectable formulations. The generic variations of the drug have been the commonest varieties listed on PDLs. Over half of plans (masking 42 million Medicaid recipients) had state-defined PDLs, and these plans have been much less more likely to report masking the generic injectable naloxone.
Notably, three states with no MCPs masking a minimum of one type of naloxone—Ohio, Kentucky, and Tennessee—had excessive opioid overdose charges, though the researchers warning that extra knowledge is required to grasp the causes of those excessive dying charges.
The findings did present that MCPs in states with low overdose charges have been extra more likely to cowl all types of naloxone and fewer more likely to impose amount limits. Additional analysis ought to establish how Medicaid protection of naloxone contributes to recipients’ well being, and MCPs ought to work to ease restrictions that make it tough for individuals to really obtain this medicine.
“Reporting protection is a vital first step,” Feltus says. “Eradicating prior authorization necessities might ease administrative burden for suppliers prescribing naloxone. We do not know as a lot in regards to the impression of amount limits on naloxone however this restriction might current a barrier for Medicaid recipients who may have greater than the allowed quantity per 30 days or 12 months.”
States can take motion to extend entry to naloxone, she provides.
“States can require that MCPs cowl all types of naloxone by together with all formulations on a uniform most well-liked drug checklist, or in contract necessities with MCPs.”
Extra info:
Sage R. Feltus et al, Medicaid Managed Care Naloxone Protection and Administration, JAMA Community Open (2025). DOI: 10.1001/jamanetworkopen.2025.12866
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Majority of Medicaid managed care plans cowl opioid overdose reversal drug naloxone, however entry boundaries stay (2025, June 27)
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