Over-the-counter Narcan on shelves next week; overdose reversal spray may cost too much for many who need it

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Over-the-counter naloxone nasal spray, or Narcan, will hit drugstore shelves next week. The lifesaving spray reverses opioid overdoses but used to require a prescription. “Big-box outlets like Walgreens, CVS, Walmart and Rite Aid said they expected Narcan to be available online and on many store shelves early next week,” report Jan Hoffman and Noah Weiland of The New York Times. “Narcan is already a staple for emergency personnel and street outreach teams. Now scientists and health officials hope Narcan will eventually become commonplace in public libraries, subways, dorms, corner delis and street vending machines.”

Walgreens announced that it will sell a two-pack of Narcan for $44.99, and the spray qualifies as a medical expense for health savings accounts and flexible spending accounts, according to the Flex Spending Store. But at $45 for two doses, the treatment may be out of reach for some that need it the most. “When Narcan was available only by prescription, public and private insurance readily covered it. But those plans typically restrict coverage of over-the-counter drugs,” the Times reports. “Some state Medicaid programs have already announced that they will cover Narcan when it becomes available over the counter. Those states include Missouri, California, Massachusetts, Washington, Rhode Island and Oregon.”

Where retailers display Narcan, such as behind the counter, could also prevent people from picking it up. “Behavioral health experts say that customers may be reluctant to ask store workers for Narcan, fearing raised eyebrows and dismissive comments—marks of the pervasive stigma surrounding drug use and addiction,” Hoffman and Weiland explain. “Rite Aid, Walgreens, Walmart and CVS also said that Narcan could be purchased next week through their online sites, offering greater privacy.” Brendan Saloner, an addiction policy expert at Johns Hopkins, told the Times: “Stigma will always be there, but I think there’s been a sea change in how the public perceives naloxone over the last decade, and many more people are willing to carry it.”

Narcan won’t be the only company in the overdose reversal OTC field; the drug’s price will likely fall with market competition and some insurance companies may offer coverage. The Times reports, “CVS is encouraging customers to ask for Narcan at the pharmacy counter ‘so our pharmacy teams can check a patient’s insurance plan for potential savings on prescription naloxone products,’ a spokesman said. . . . Earlier this summer, the Food and Drug Administration gave over-the-counter approval to RiVive, a naloxone spray expected in early 2024. RiVive, manufactured by Harm Reduction Therapeutics, is intended as a low-cost product largely for outreach groups."