HMN 2025: How Majority of Medicaid managed care plans cowl opioid overdose reversal drug naloxone, however entry limitations stay

A brand new study discovered that the majority plans in 40 states and Washington, DC coated a minimum of one type of the opioid overdose reversal drug naloxone, though sure restrictions and amount limits should forestall individuals from accessing this life-saving drug.

In 2023, the US Food and Drug Administration approved the overdose reversal drug naloxone, generally generally known as Narcan, for over-the-counter (OTC) use. While hailed as a public well being success for rising entry to this life-saving drug, this OTC choice stays out of attain for individuals who can not afford the $45 common price ticket for a two-dose field.

Medicaid recipients are a low-income inhabitants that disproportionately experiences opioid overdoses, so entry to low- or no-cost naloxone by means of insurance coverage might help to save lots of lives. A brand new study led by Boston University School of Public Health (BUSPH) investigated Medicaid managed care plan protection of naloxone throughout the nation.

Published in JAMA Network Open, the study discovered that the majority Medicaid managed care plans (MCPs) cowl a minimum of one of many 4 formulations of naloxone. Eighty % of Medicaid recipients, which embrace greater than 70 million individuals, are enrolled in these plans. The study is the primary to evaluate naloxone protection inside MCPs.

“These findings are necessary as a result of over-the-counter naloxone can nonetheless be very costly and insurance coverage protection can scale back the associated fee barrier to accessing this drug,” says study lead and corresponding creator Sage Feltus, analysis affiliate within the Department of Health Law, Policy & Management (HLPM) at BUSPH. “The overdose loss of life charge amongst Medicaid beneficiaries is twice as excessive because the overdose charge among the many basic US inhabitants. Low-barrier and low-cost naloxone may assist get this important remedy into the fingers of people who find themselves at excessive danger for overdose loss of life.”

The study’s senior creator is Dr. Maureen Stewart, analysis affiliate professor in HLPM at BUSPH, and co-authors embrace Dr. Jeffrey Bratberg, scientific professor at The University of Rhode Island College of Pharmacy, and Sophia Balkovski, a doctoral trainee on the Heller School for Social Policy and Management at Brandeis University.

After rising sharply in the course of the COVID-19 pandemic, drug overdose deaths involving opioids declined to 83,140 in 2023, adopted by a big drop to 54,743 deaths in 2024, in response to provisional information from the Centers for Disease Control and Prevention.

Naloxone, which is taken into account the cornerstone of the harm-reduction strategy to the nation’s opioid overdose emergency, can shortly reverse the consequences of opioids corresponding to heroin, oxycodone, and fentanyl. Experts have long sought to extend consciousness of and entry to this remedy to soundly and successfully scale back deaths from opioid use.

For the research, the researchers reviewed the popular drug lists from 264 MCPs that coated 65.3 million Medicaid recipients in 40 states and Washington, DC. Insurance firms and states can use these most well-liked drug lists to barter rebates with drug producers. The staff examined MCP reported protection and administration of all accessible formulations of naloxone: model and generic 4-mg nasal sprays; a generic injectable; and a more recent, high-dose, model nasal spray in 8 mg. They additionally reviewed publicly accessible information on state-level opioid overdose deaths.

While amount limits and different restrictions assorted by plan, 94% of plans reported masking a minimum of one generic injectable or 4-mg generic/model variations of the nasal spray of naloxone, and 91% coated the 4-mg generic or model nasal spray and injectable formulations. The generic variations of the drug had been the most typical kinds listed on PDLs. Over half of plans (masking 42 million Medicaid recipients) had state-defined PDLs, and these plans had been much less more likely to report masking the generic injectable naloxone.

Notably, three states with no MCPs masking a minimum of one type of naloxone—Ohio, Kentucky, and Tennessee—had excessive opioid overdose charges, though the researchers warning that extra information is required to grasp the causes of those excessive loss of life charges.

The findings did present that MCPs in states with low overdose charges had been extra more likely to cowl all types of naloxone and fewer more likely to impose amount limits. Further analysis ought to establish how Medicaid protection of naloxone contributes to recipients’ well being, and MCPs ought to work to ease restrictions that make it tough for individuals to really obtain this remedy.

“Reporting protection is a vital first step,” Feltus says. “Removing prior authorization necessities could ease administrative burden for suppliers prescribing naloxone. We do not know as a lot concerning the influence of amount limits on naloxone however this restriction may current a barrier for Medicaid recipients who might have greater than the allowed quantity monthly or yr.”

States can take motion to extend entry to naloxone, she provides.

“States can require that MCPs cowl all types of naloxone by together with all formulations on a uniform most well-liked drug checklist, or in contract necessities with MCPs.”