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In March 2023, the U.S. Food and Drug Administration (FDA) approved Narcan’s 4mg naloxone hydrochloride nasal spray for over-the-counter use. Emergent BioSolutions, Narcan’s manufacturer, has now shipped supplies across the United States.

Thank you to The Washington Post for including MATTERS’ Chief Medical Officer, Dr. Joshua Lynch, in this discussion!

Narcan, the nasal spray that reverses opioid overdoses, is hitting store shelves this month for the first time as an over-the-counter medication — a milestone in the fight against the nation’s overdose crisis.

Manufacturer Emergent BioSolutions said last week that it has shipped hundreds of thousands of the two-spray kits, at a suggested retail price of $44.99. Major retailers such as CVS, Rite Aid, Walgreens and Walmart say the kits will be available on shelves in coming days. Companies are also selling the sprays online.

Narcan is a nasal spray version of naloxone, the opioid antidote credited with saving countless lives during the nation’s overdose crisis. More than 110,000 people are believed to have died of drug poisonings last year, more than two-thirds of them from synthetic opioids such as fentanyl. Prescription Narcan is widely used, carried by paramedics and police officers, distributed by groups that work on the streets to reduce the dangers of an increasingly toxic drug supply, and stocked in libraries, schools and even vending machines.

The Food and Drug Administration in March approved Narcan for over-the-counter use, a measure that advocates hope will expand its use by positioning the spray in supermarkets, corner stores and gas stations — and have it stored in first-aid kits or with families worried teens might overdose on counterfeit pills laced with fentanyl.

How does Narcan work?

Naloxone reverses the effects of opioids in the brain, restoring slowed or halted breathing. Narcan is not habit-forming — and is safe to use even in someone who has fallen unconscious but who turns out not to be overdosing on an opioid, said Joshua J. Lynch, associate professor of emergency and addiction medicine at the University at Buffalo.

Don’t test the spray first, Lynch said. “Giving the full vial into someone’s nose — and calling 911 right away — is the best practice,” he said.

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How expensive is Narcan?

Public health experts have long been concerned that over-the-counter Narcan will be too expensive for regular drug users — who are most at risk of overdosing. Still, over-the-counter Narcan for about $45 is an option for people who feel uncomfortable getting the medication from harm-reduction organizations, said Hansel E. Tookes III, an infectious-disease doctor at the University of Miami Miller School of Medicine.

“Of course, I would prefer that the Narcan were cheaper, but $45 to save a human life is a fantastic step in increasing access to lifesaving overdose prevention,” said Tookes, who founded the IDEA Exchange, a Miami program that exchanges used syringes for sterile ones and distributes naloxone to users on the streets.

Most states have used a system that allows Narcan to be dispensed by pharmacists without having to get an individual prescription from a doctor. Narcan going over-the-counter will make it easier to distribute in states with pharmacy restrictions, and advocates believe it will normalize use across a broad spectrum of U.S. society.

Private and public health insurance generally has covered Narcan and liquid naloxone as a prescription medication but can restrict paying for over-the-counter products. In some states such as Massachusetts, some health insurance companies and Medicaid programs have said they will still pay the full cost of over-the-counter Narcan.

Coverage under Medicare, the government health insurance program for people 65 and older and for the disabled, is also limited. By law, Medicare Part D can’t cover over-the-counter medications outside of limited exceptions. Medicare Part B will pay for take-home supplies of naloxone provided by programs treating opioid use disorder. Private insurers participating in Medicare Advantage can choose to cover over-the-counter naloxone as supplemental benefit. CMS said it encourages plans to do so.

CVS said it is encouraging customers seeking Narcan to check with pharmacy-counter employees about whether their insurance plan offers savings on prescription naloxone versions.

Health departments, state governments and harm-reduction groups can purchase Narcan under a “public interest” price, which has been lowered to $41 per kit, Emergent said in a news release last week.

Many outreach organizations receive Narcan from government agencies, or rely on cheaper liquid naloxone, which must be administered through a syringe. Harm-reduction groups say scaling up inexpensive liquid naloxone is key to saving lives. Remedy Alliance, a national nonprofit distribution organization, sells the liquid version for under $4 a dose, or gives them away free, to harm-reduction groups that struggle with funding. Remedy Alliance says it has distributed more than 1.5 million doses during the past year.