Narcan, soon available over the counter, is covered by some but not all Mass. insurers 

Public health experts say increased distribution of naloxone, the drug that can reverse an overdose, is helping more drug users survive an overdose. (Jesse Costa/WBUR)
Public health experts say increased distribution of naloxone, the drug that can reverse an overdose, is helping more drug users survive an overdose. (Jesse Costa/WBUR)

Narcan, the nasal spray that can revive someone after an opioid overdose, will be available without a prescription in the next few weeks. It’s the first brand of naloxone to be sold over the counter in pharmacies, making this life-saving drug as easy to buy as aspirin or cough medicine.

But Narcan is expected to be much more expensive than common medicines sold on pharmacy shelves. Emergent BioSolutions, which makes Narcan, has said the goal is to sell the drug for less than $50, but retailers will set their own prices.

In Massachusetts, naloxone is already available through a statewide prescription that allows pharmacists to distribute the drug on request. It is covered by insurance and is available at no cost through many state and nonprofit-funded distribution programs.

Advocates who credit naloxone with reversing more than 2,000 overdoses so far this year, worry the cost of over-the-counter Narcan would make it less, not more, available. They’ve been urging health insurers to keep covering Narcan after it becomes a nonprescription drug.

On Thursday, Blue Cross Blue Shield of Massachusetts said it will continue to pay the full cost of Narcan for members.

“Naloxone has become the standard treatment for opioid overdose and making it available more widely is a key strategy in controlling the overdose crisis,” said BCBSMA’s chief medical officer, Dr. Sandhya Rao, in a statement. “This is especially critical as opioid-related overdose deaths in Massachusetts continue to rise.”

Massachusetts set a new record last year with 2,357 deaths after a drug overdose.

MassHealth, the state’s Medicaid program, will also still provide Narcan at no cost. There will be no limits on the number of kits members can acquire monthly.

Massachusetts residents who have private insurance through Harvard Pilgrim Health Care or Tufts Health Plan will have to pay for Narcan purchased over the counter, but generic versions of naloxone will remain available without a co-pay for members who go to a pharmacist. A spokeswoman said, in an email, that the insurers “are committed to ensuring our members continue to have access to naloxone.”

There are several generic or cheaper versions of naloxone. RiVive, which is produced by a nonprofit pharmaceutical company, has also been approved to switch from prescription only to over-the-counter sales early next year. Company leaders have said they hope it will retail for as little as $36 for a two-dose kit.

In Massachusetts, Narcan remains the most widely known brand. The state has distributed 97,500 doses of naloxone so far this year, almost all of which has been Narcan.


Learn to Cope, the statewide family support network, gives out hundreds of state-funded Narcan kits every year. Staff counsel families about the need to stock the drug and provide training about how to use it. Founder and CEO Joanne Peterson says some generic versions of naloxone are harder to use and thus not as effective in an emergency.

Peterson says this is the wrong time to make Narcan more expensive for some and less available.

“I feel anxiety about this,” said Peterson. “It’s bad timing. We need to get a handle on this crisis.”

Kim Powers, founder of the mobile harm reduction program Access HOPE on Cape Cod, has distributed 5,368 Narcan kits since the start of last summer. Powers says she sees or hears about the impact of naloxone almost every day — from people who use it to save lives and from people who wish they’d had it on hand.

Powers would like to see many more people carry Narcan, including parents, executives and other people who may not think they need it.

“When we look at overdose deaths there are lots of occasional users,” Powers said. “We aren’t reaching that community with Narcan. Everyone needs it.”

Powers says making naloxone available over the counter might help, but not if people think it’s too expensive.

Editor's note: This story has been updated to reflect the state's response to an inquiry about Narcan coverage through MassHealth, the state Medicaid program. Officials do not plan to limit the amount of Narcan MassHealth will cover for members on a monthly basis.

This article was originally published on August 24, 2023.


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Martha Bebinger Reporter
Martha Bebinger covers health care and other general assignments for WBUR.



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