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Over-the-counter Narcan to cost less than $50 for a two-pack, company says

The opioid overdose reversal drug will be available without a prescription later this year, but experts fear the price could be too high.
People Deliver Safe Injection Supplies During Pandemic
A dose of Narcan.Craig F. Walker / Boston Globe via Getty Images file

When Narcan finally becomes available over the counter later this year, the price may put the lifesaving antidote out of reach for many people, experts say.

Emergent BioSolutions said Thursday that it plans to price the opioid overdose reversal medication at less than $50 for two doses.

“In my own clinical practice, there have been times when families have needed to pay $30 for a copay for Narcan, and this has been too expensive for them,” said Dr. Scott Hadland, an addiction specialist at Mass General for Children in Boston. “In many instances, the families I work with have chosen not to pay this.”

The Food and Drug Administration approved Narcan, or naloxone, for over-the-counter use last month, a move experts hailed as one that's expected to increase access to the crucial medication. The approval means the rescue drug could be sold in places such as convenience stores, grocery stores and vending machines, in addition to drugstores.

Although the drug was previously prescription-only, many states have workarounds that allow people to get it directly from a pharmacist. In many places, it's also available for free at community centers, local health departments and needle-exchange programs. 

That's important because it removes barriers to access, said Dr. Leslie Walker-Harding, the chair of pediatrics at the University of Washington and chief academic officer at Seattle Children's Hospital, who equated it to having defibrillators in public spaces.

The below-$50 price tag for Narcan announced by Emergent BioSolutions is less than the current list price for the medication, which is around $130 for a two-dose box, according to GoodRx, a group that tracks prescription drug prices.

Even so, it may be too much.

The price tag “could seem like a small price to pay to save someone’s life, but at that price there will be many who will not be able to afford the purchase,” Walker-Harding said.

“It is unlikely that most folks will drop $40 to $50 on Narcan,” said Dr. Michael Barnett, an associate professor of health policy and management at the Harvard T.H. Chan School of Public Health. “They are also prioritizing rent, food, and also paying for opioids, which we want them to decrease.”

Many people with opioid addiction live well below the federal poverty line, Barnett said.

A report from KFF, a nonprofit organization focused on health policy, found that 6 in 10 uninsured adults with opioid use disorder have low incomes. More than a third of them had incomes 100% to 200% below the federal poverty line.

The over-the-counter Narcan will come packaged with two 4-milligram doses, administered as a nasal spray, according to Matt Hartwig, a spokesperson for Emergent BioSolutions. Both doses may be needed to reverse an overdose. It is expected to come in a larger box with images and detailed instructions to help people administer the drug more easily.

Most insurance companies cover the prescription version of Narcan, leaving patients with copays.

Over-the-counter drugs, however, generally aren't covered by insurance, meaning people would have to pay the full price, said Larry Levitt, the executive vice president for health policy at KFF.

"There’s an inevitable tension when drugs like Narcan are approved for over-the-counter sale," Levitt said. "These drugs become more accessible over the counter, but also ironically more expensive for patients in many cases if insurance doesn’t cover them."

Hartwig, of Emergent, said it is not yet known whether insurance companies will cover the over-the-counter version of Narcan.

NBC News has asked the Centers for Medicare and Medicaid Services whether the federal government will provide coverage for the drug.

Barnett said that if insurance doesn't cover the drug, he hopes Narcan will still be available by prescription or could be paid for via a voucher. Generic versions of Narcan, sold by other drugmakers, are still available with a prescription.

"The whole point of having Narcan is protecting those who are using it," Barnett said.

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