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CMS Should Pursue Strategies To Increase the Number of At Risk Beneficiaries Acquiring Naloxone Through Medicaid


On average, 130 people in the United States die every day from an opioid overdose. The drug naloxone plays a critical role in saving the lives of those who abuse or misuse opioids-one review of emergency data found that, when given naloxone, 94 percent of people survived their overdose. In April 2018, the U.S. Surgeon General issued an advisory stating that increasing the availability and targeted distribution of naloxone is a critical component of efforts to reduce deaths from opioid related overdoses. Similarly, Federal and State agencies have undertaken numerous efforts to increase access to naloxone for those in need. However, it is widely acknowledged that more needs to be done. Medicaid covers almost 40 percent of nonelderly adults with opioid use disorder, underscoring the key role that the program can play in providing access to naloxone.


We used State-reported Medicaid data to determine how total utilization for naloxone changed in the program between 2014 and 2018. Using manufacturer-reported sales data, we determined the proportion of all naloxone distributed in the United States that was paid for under Medicaid each year between 2014 and 2018. We used data on Medicaid drug spending to examine how statutory rebates-paid by manufacturers to States-affected Medicaid payments for naloxone during this period.


Access to naloxone for Medicaid beneficiaries has expanded significantly, with the program paying for 21 times more doses in 2018 than in 2014. Despite this growth, Medicaid paid for only 5 percent of all naloxone distributed in the United States in 2018. This figure is especially concerning given that (1) Medicaid covers almost 40 percent of nonelderly adults with opioid use disorder (OUD) and (2) some States with extremely high overdose mortality rates paid for relatively little naloxone under Medicaid.

Because of statutory rebates paid by manufacturers to Medicaid, the program has been able to recoup a large percentage of its spending on naloxone. For example, in 2018, Medicaid's net cost for Narcan in 2018 was less than the substantially discounted price that Narcan's manufacturer offered to public health organizations for this "community use" version of naloxone.


CMS and State Medicaid agencies can be encouraged by their progress to date in increasing access to naloxone while also continuing to look for ways to further expand naloxone availability under Medicaid. We recommend that CMS pursue strategies to increase the number of at-risk beneficiaries acquiring community-use versions of naloxone through Medicaid. CMS did not explicitly concur with our recommendation but stated that it is already pursuing multiple strategies to increase the number of at-risk beneficiaries acquiring naloxone through Medicaid and will continue to do so.