Most Medicaid Managed Care Plans Cover Naloxone for Opioid Overdose Reversal, But Barriers Persist

A recent study highlights that nearly all Medicaid managed care plans in 40 states and Washington, D.C., provide coverage for at least one form of naloxone, a vital medication used to reverse opioid overdoses. Despite this broad coverage, certain restrictions such as limits on quantity and prior authorization requirements may still impede access for many individuals at high risk of overdose.

In 2023, the FDA approved naloxone, commonly known as Narcan, for over-the-counter availability, aiming to enhance access. However, the high cost of approximately $45 for a two-dose pack remains a barrier for uninsured or low-income populations, including Medicaid recipients who experience disproportionately high overdose rates.

The Boston University School of Public Health led a landmark investigation published in JAMA Network Open, analyzing 264 Medicaid managed care plans covering over 65 million people. The study found that 94% of these plans cover at least one generic injectable or nasal spray formulation of naloxone, with especially high coverage of the nasal spray versions.

The research underscores the importance of insurance coverage in reducing cost barriers among Medicaid beneficiaries, whose overdose death rates are twice those of the general population. Experts like Sage Feltus from BUSPH emphasize that removing barriers such as prior authorization and limiting restrictions could significantly improve access to this lifesaving drug.

States can improve access by incorporating comprehensive naloxone coverage into their Medicaid plans, including all formulations on standardized drug lists, to ensure wider availability. The study also noted that states with the highest overdose rates, like Ohio, Kentucky, and Tennessee, lack plans with complete naloxone coverage, suggesting a need for targeted policy action.

Overall, while broad coverage exists, reducing administrative hurdles and restrictions could be crucial steps toward making naloxone more accessible to those most at risk of opioid overdose, ultimately saving more lives in the ongoing epidemic.