Medicaid covered OTC naloxone nasal spray in 2024 while Medicare Part D largely did not in 2025

The Government Accountability Office reports that Medicaid programs covered the over-the-counter naloxone nasal spray for enrollees in 2024, whereas Medicare Part D plans generally did not provide coverage for the same product in 2025. Both programs continued to cover naloxone injectable formulations during those years.

Out-of-pocket costs varied by drug form and brand status. For Medicare Part D enrollees, generic naloxone injections carried a median copay ranging from $3 to $10, while brand-name high-dose nasal sprays required a median coinsurance of 25 percent to 35 percent. Under a 35 percent coinsurance rate, a $150 nasal spray would cost the enrollee about $53; at a 25 percent rate, the cost would be roughly $38. Among the four Medicaid states examined, two reported no copays for naloxone, and the other two reported copays of less than $5.

GAO's analysis relied on Centers for Medicare & Medicaid Services Part D data for 2025 and Medicaid drug-reimbursement data for all 50 states and the District of Columbia for 2024. The agency also interviewed representatives from four Part D plan sponsors - selected among the top eight by national market share - and four state Medicaid programs chosen for geographic diversity and variation in overdose rates.

The draft report was provided to the Department of Health and Human Services, which supplied technical comments that GAO incorporated. The agency notes that declines in opioid overdose deaths since 2023 may be partly attributable to expanded access to these reversal medications.