Increasing availability of naloxone, the life-saving drug used to reverse opioid overdoses, is critical, especially because the COVID-19 pandemic has accelerated the number of such overdoses. In this study, we track changes in Medicaid spending on naloxone, its price per unit, and Medicaid-covered naloxone prescriptions for generic naloxone products, the brand-name Narcan nasal spray, and the Evzio autoinjector.

We find dramatic increases in Medicaid prescriptions for and spending on naloxone between 2010 and 2018. This may partially owe to the new naloxone formulations that offer advantages in administration. For example, needle-free naloxone nasal spray is highly effective and easy to use, and the quick-acting autoinjector naloxone works for people with nasal abnormalities (a substantial share of those with opioid use disorder). Ideally, prescribers could write naloxone prescriptions suited to each Medicaid patient’s circumstances. However, we find that the autoinjector formulation was not offered in any state Medicaid program in 2018, likely because of their very high and variable prices per prescription in years prior and the lack of generic equivalents.

Except for autoinjector pricing, our results confirm other research findings that state Medicaid programs negotiate relatively low prices for naloxone drugs. Average generic naloxone rebate-adjusted prices in Medicaid increased by 29 percent between 2010 and 2018, rebate-adjusted prices for a two-pack prescription of Narcan nasal spray decreased by 23 percent between 2016 and 2018, and rebate-adjusted prices for a two-pack prescription of Evzio varied widely across states and time when it was reimbursed from 2014 to 2017. Without new federal policies regulating prices and/or promoting robust price competition, including for generics, Medicaid enrollees’ naloxone options will remain limited, potentially worsening the overdose crisis.

For more on this project, Tracking Medicaid-Covered Prescriptions to Treat Opioid Use Disorder, and to view quarterly data, visit the project page.