A new study led by Boston University School of Public Health (BUSPH) reveals that nearly all Medicaid managed care plans (MCPs) in the U.S. cover at least one formulation of naloxone, a critical drug for reversing opioid overdoses. Published in JAMA Network Open, the study highlights both progress and persistent challenges in ensuring access to this life-saving medication for Medicaid recipients, who face disproportionately high overdose rates.
The research team analyzed data from 264 MCPs across 40 states and Washington, D.C., covering 65.3 million Medicaid beneficiaries. They found that 94% of plans included at least one form of naloxone, such as generic injectable or 4-mg nasal spray versions. However, restrictions like quantity limits and prior authorization requirements may still hinder access for those in need.
Naloxone, approved for over-the-counter (OTC) use by the FDA in 2023, remains costly for many, with OTC prices averaging $45 for a two-dose box. Medicaid coverage is vital for low-income individuals, as the overdose death rate among beneficiaries is twice the national average.
Dr. Sage Feltus, the study’s lead author, emphasized the importance of insurance coverage in reducing cost barriers. “Low-barrier, low-cost naloxone could save lives by reaching high-risk populations,” she said. The study also noted disparities in coverage, with three high-overdose states-Ohio, Kentucky, and Tennessee-lacking universal MCP coverage for naloxone.
“Reporting coverage is a critical first step,” Feltus added. “Removing prior authorization and quantity limits could further improve access.”
While Medicaid coverage of naloxone is widespread, the study calls for policy changes to eliminate restrictions and ensure equitable access. States could mandate uniform coverage across all MCPs or include naloxone in preferred drug lists. As opioid overdose deaths decline-from 83,140 in 2023 to 54,743 in 2024-expanding naloxone access remains key to sustaining progress in harm reduction.
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