Over-the-counter Narcan will cost $45 at major retail pharmacies

The overdose reversal nasal spray Narcan will be available over the counter at many large chain pharmacies in the coming days, at a cost of $44.99 for a two-dose pack.

The company that makes the spray is shipping out hundreds of thousands of doses to retailers starting Wednesday, marking the first time the drug will be available without a prescription online and at pharmacies nationwide.

Federal officials hope the change, which follows the FDA approval of over-the-counter Narcan sales in March, will save lives. The U.S. set a record for the number of fatal overdoses in 2022.

Emergent Biosolutions, the company that makes Narcan, is shipping packs of 2-4 milligram doses for over-the-counter sales to major retailers first, including Walgreens, Rite Aid and CVS. The company said it will continue sending the spray to other retailers over several weeks. The pharmacy chains said they will charge the suggested retail price.

Advocates have worried that over-the-counter sales of Narcan could be too costly for many consumers.

Emergent Biosolutions suggested a price tag that is lower than the current cost of prescription Narcan for individuals without health insurance. Some consumers may pay less — or nothing at all — if the drug is covered by their insurance plans.

"This is really about access and opening the lens, or the floodgates, for so many more people to have easy access to Narcan — in the event they find themselves in a position to potentially save someone's life," said Emergent Biosolutions Senior Vice President Paul Williams.

But some advocates said $44.99 is still expensive. "For some people, $44 is a small price to pay to have access to the medication," said Sheila Vikharia, deputy research director for the Drug Policy Alliance. "But there are of course going to be people for whom $44 is out of reach."

Narcan is a brand name for the drug naloxone, which can reverse an overdose in minutes. There are generic brands of naloxone, such as RiVive, which is expected to be available over the counter in pharmacies next year.

CVS Health Corporation said prescription-free Narcan will be available at most of its stores and online in early September. The company said consumers will be able to order the spray online, and pick it up in-store or have it delivered. A pharmacist can also instruct patients how and when to use the spray.

"We hope the FDA's approval of over-the-counter naloxone will lead to more naloxone products in the marketplace to help ensure affordable access for customers," said CVS Health spokesman Matt Blanchette.

Rite Aid Corporation said it will stock the life-saving spray in all of its stores in September. The over-the-counter version of Narcan will be available in the pain medication aisle, the company said.

Walgreens plans to sell the drug at front registers and pharmacy counters. The retailer said Narcan will be available online starting September 5th and in its stores September 7th.

Up until now, naloxone has been available by prescription and by request at pharmacy counters in many states. In addition, there are state and nonprofit programs that distribute naloxone for free.

Emergent Biosolutions set a slightly lower price — up to $41 per carton — for public interest groups. An FDA study found that in 2021, most of the almost 17 million doses of naloxone distributed in the U.S. were given out by non-retail groups.

In Massachusetts, state programs have distributed 97,500 doses of naloxone so far this year, and most of it has been Narcan. The state Department of Public Health said the new price it negotiated for Narcan will save the state $6.14 per carton over the current cost.

Advocates said they welcome the increased availability of Narcan, but hope it will not affect other efforts to combat the opioid epidemic, including the distribution of free Narcan by states and nonprofit groups.

"We can't make the mistake of assuming the problem is solved because it's available over the counter," said Kevin Roy, chief public policy officer for the nonprofit addiction advocacy organization Shatterproof. "It's a tool in the toolbox but not the only one that's important."