Naloxone (most often under the nasal formulation) is a critical tool to combating the deadly overdose epidemic from opioids in our community. CareOregon covers nasal naloxone without prior authorization. The inherent nature of how naloxone is administered (not able to be self-administered) raises questions about insurance coverage. Who should be able to fill a prescription for naloxone if they cannot use it on themselves? Due to the nuance of this issue, this is a CareOregon specific response. Other insurers could have different definitions and dispensing pharmacies may also have different applications as they fill prescriptions.
Who does CareOregon endorse getting naloxone (and using their prescription benefits for)?
- At risk individuals, defined as:
- A diagnosis of opioid use disorder, including those on MAT.
- Including history of OUD.
- Decreased tolerance due to recent abstinence (such as released from prison or other supervised setting opioid use was prohibited).
- > 50 MED on prescription opioids.
- Concomitant use of opioids + other sedating drugs such as benzodiazepines.
- Risk of witnessing an opioid overdose
- A close relationship with a friend or family member that meets an above definition.
Who does CareOregon NOT endorse using their benefits to receive naloxone?
- Low-risk opioid use: acute Rxs, low MED (<50), no other risk factors.
- General “Good Samaritan Use”
- No direct link to a high-risk individual
- Note: This group is legally able to receive a prescription, but not an appropriate link for insurance coverage.
- Encourage evaluation for other public health programs that may provide.
Covered naloxone formulations on the CareOregon formularies
- Narcan Nasal 4 mg/0.1 mL (now available as a generic)
- Kloxxado Nasal Spray8 mg/0.1 mL ($63 per dose)
- Zimhi Prefilled Syringes 5 mg/0.5 mL ($63 per dose)
- Naloxone 0.4 mg/mL injection vials
- Naloxone 2 mg/2 mL prefilled syringes
- Evzio- At a cost of over $4,000 per prescription, it is cost prohibitive to cover.