The U.S. Government Accountability Office on Monday released a report detailing Medicare and Medicaid coverage for opioid overdose reversal medications. The report found that all enrollees in Medicare Part D and Medicaid had coverage for some form of naloxone in 2025 and 2024, respectively.
According to the agency, a drop in fatal overdoses starting in 2023 could partly be due to increased availability of medications like naloxone and nalmefene. However, researchers have raised concerns about access to newer over-the-counter versions, as insurance may not cover over-the-counter drugs.
Medicaid covered the over-the-counter nasal spray for enrollees in 2024, while Medicare Part D plans generally did not cover them in 2025, the report says. Both programs covered naloxone injectables. Coverage of nalmefene, a newer and longer-acting medication, was less common.
Out-of-pocket costs for Medicare Part D enrollees varied by drug formulation and brand status. Generic naloxone injections had the lowest costs, with a median copay ranging from $3 to $10. The highest costs ranged from a 25% to 35% median coinsurance for brand high-dose naloxone and nalmefene nasal sprays. An enrollee buying a $150 covered nasal spray would owe approximately $38 or $53, based on their specific coinsurance percentage.
In a review of four selected states, Medicaid enrollees in two states had no copays for the medications. Enrollees in the other two states had copays of less than $5, the GAO reported.