Is naloxone at the counter getting less costly?

Patients paid less money out of pocket for naloxone from 2018 through 2022, according to a new analysis published in JAMA. The research, which was based on data from the IQVIA Longitudinal Prescription database, revealed that the mean out-of-pocket cost per prescription declined from $22.51 in 2018 to $10.02 in 2022.

High costs have been identified as a possible contributor to low prescribing rates for the opioid overdose antidote. As out-of-pocket costs declined during the study period—likely as a result of price negotiations, market competition, and changes in PBM preferences—the number of dispensed prescriptions spiked by more than 187%.

Patient responsibility varied across payer types: private or commercial, self-pay, Medicaid, Medicare, assistance, and unknown status.

Mean annual out-of-pocket costs were lowest among Medicaid payers and highest for self-pay prescriptions and for brand-name naloxone (Narcan) prescriptions that benefited from a discount card, coupon, or voucher.

In general, nasal naloxone is pricier than the injectable product, and the out-of-pocket cost for OTC naloxone—which was approved in 2023—was higher than for insurance-covered prescriptions but lower than for uninsured payers.

Out-of-pocket costs for naloxone also trended higher for older adults, likely due to Medicaid criteria, but the authors emphasized that expanding access in this population—which registered the biggest relative gain in drug overdose fatalities from 2020 to 2021—is critical.