Medicare Part D generally excluded over-the-counter naloxone nasal spray in 2025, though the program covered injections, leaving enrollees’ costs dependent on formulation, a federal review found.
The U.S. Government Accountability Office (GAO), in a review published Nov. 9, examined Centers for Medicare & Medicaid Services data for Part D in 2025 and Medicaid reimbursement records for 2024, the latest years available for its analysis. The records showed enrollees had coverage for some form of naloxone, but that did not mean every product was covered.
Part D plans generally did not cover the OTC nasal spray, while Medicaid data showed spray coverage in 2024. Both programs covered naloxone injections in the years GAO reviewed. Its Medicaid analysis included all 50 states and the District of Columbia. GAO used recorded drug use as evidence of state coverage, while cautioning that a state without recorded use might still cover the medicine.
The amount beneficiaries paid varied with the product. For generic naloxone injections, median Part D copayments were $3 to $10. Median coinsurance for branded high-dose naloxone and nalmefene nasal sprays ranged from 25% to 35%. At a covered price of $150, those rates would leave a beneficiary paying about $38 or $53. In GAO’s four-state Medicaid sample, two states charged no copay and two charged less than $5; those results are not a nationwide estimate.
Medicare Part D generally does not cover OTC medicines. In a 2025 review, the Department of Health and Human Services (HHS) Office of Inspector General reported that more than 750,000 enrollees received overdose-reversal drugs through Part D in 2023, with naloxone accounting for nearly all of them. The office said the move of the most commonly dispensed naloxone form to OTC status was removing Part D coverage for that form and could increase enrollees’ costs.
The Food and Drug Administration (FDA) approved 4-milligram Narcan nasal spray for OTC use in March 2023 and its first prescription nalmefene nasal spray that May. In June 2026, the FDA approved another 4-milligram OTC naloxone spray, after the periods covered by GAO’s review.
