OTC Narcan hits Philly store shelves — but with early cost and access barriers

Drug stores in Philadelphia, and across the country, began stocking bright pink boxes of Narcan earlier this month.

The boxes contain two doses of nasal spray naloxone, the opioid overdose reversal medication. It’s the first of its kind to be sold and marketed as an over-the-counter product — no prescription required.

Harm reduction advocates and addiction treatment experts hope that making Narcan nasal spray available to buy over-the-counter will expand access to lifesaving medication.

However, the price point and a lack of supply on aisle shelves may hamper any success of getting Narcan into more people’s hands.

“The problem is the illusion that things are changing when they’re not,” said Shoshana Aronowitz, a family nurse practitioner and assistant professor at the University of Pennsylvania’s School of Nursing. “Just people thinking, ‘Oh, we’re making progress. Great, naloxone is so available now, don’t need to think about this anymore.’ When that’s not true.”

In Philadelphia, a record 1,276 people died from drug overdoses in 2021. A vast majority of cases involved fentanyl, a highly potent synthetic opioid.

A consistently high number of deaths each year has spurred more efforts to boost the availability of Narcan, which is typically available through free distribution programs or as a generic medication that needs to be purchased at a pharmacy.

In March, the FDA approved Emergent BioSolution’s Narcan nasal spray as a medication that could be sold without a prescription.

But Dr. Lewis Nelson, addiction medicine specialist and chair of the Department of Emergency Medicine at Rutgers New Jersey Medical School, said the manufacturer’s recommended retail cost of $44.99 already puts it out of reach for many.

“And if you have a true substance use problem, and you had $45 in your pocket, this is not probably high on your priority list of what to spend it on, whether that’s food or drugs or something else,” he said.

There’s nothing stopping individual stores and pharmacies from charging more. At least one drug store in Philadelphia was selling the new nasal spray for $72 per box, which Aronowitz said could deter anyone with limited financial means and other concerns.

“That’s a lot of money to be spending on something if you need food today, if you have a headache and need ibuprofen today,” she said. “You think you’ll probably need naloxone, but it’s not a guarantee that you’ll need it today.”

People may be able to get some of the cost covered with insurance. State officials in Delaware, New Jersey, and Pennsylvania confirmed that their Medicaid health insurance programs will cover the new Narcan nasal spray, but only when a pharmacist puts it through as a prescription.

Coverage by private insurance companies will vary, but people should be able to use Health Savings Accounts or Flexible Spending Accounts to buy it as an over-the-counter medication.

Cost isn’t the only barrier, experts say. Although it’s marketed as an over-the-counter product, it doesn’t mean boxes of Narcan are available in the aisles alongside ibuprofen and cold medicines.

In fact, several stores in Philadelphia didn’t have the nasal spray on store shelves at all, but rather stocked and sold it from behind the pharmacy counter, which requires people to ask a pharmacist for help.

Aronowitz said that can be uncomfortable for a lot of people, especially if they fear being stigmatized and judged for suspected drug use, even when they are seeking Narcan for someone else.

“That’s a barrier that this [new spray] is supposed to eliminate, and it’s not eliminating it if you still have to go to the counter,” she said. “It needs to just be on the shelf and someone can take it.”

Nelson said over time, prices may drop if and when the FDA approves other brands of naloxone for over-the-counter sale.

Some stores could choose to stock the new Narcan nasal spray on aisle shelves, just like most allergy pills and vitamins, and many of the large pharmacy chains offer it for purchase online.

For now, Nelson said people with financial means will have a new way to access Narcan nasal spray.

Aronowitz said it’s also helpful to be able to point those people to a new option to get Narcan, especially as groups that distribute it for free may still have to prioritize limited supply for people who need it the most.

“We should not be under any illusion that this is going to meaningfully change things for a lot of people,” she said. “But we need to be moving in this direction, we just need to be doing it faster and with an understanding that this is just way overdue.”

If you or someone you know is struggling with substance use, SAMHSA’s National Helpline is a free, confidential, 24-hour hotline that offers referrals to local treatment facilities, support groups, and community-based organizations. Call 1-800-662-HELP for more information.

For ways to get naloxone in the Philadelphia area, visit substanceusephilly.com/get-supplies.