Blue Cross Blue Shield of Massachusetts is taking another step to combat the opioid crisis by covering the cost of the overdose reversal medication Narcan for over-the-counter use, the company said Tuesday.
The Boston-based insurer, the largest in the state, began removing copays for Narcan, the brand name for the generic drug naloxone, from most of its plans in 2018 and was the first insurer in the state to provide Narcan tool kits to employers in its membership, Blue Cross said in a statement.
“Naloxone has become the standard treatment for opioid overdose, and making it available more widely is a key strategy in controlling the overdose crisis,” Dr. Sandhya Rao, Blue Cross’s chief medical officer, said in the statement.
Last year there were 2,357 confirmed and estimated opioid-related overdose deaths in Massachusetts, a new record and an increase of 2.5 percent from 2021 and more than 9 percent from the pre-pandemic high in 2016, the state Department of Public Health said in its semiannual report in June.
Naloxone has become more widely available in recent years, thanks to a statewide standing order that allowed residents to go to a pharmacy and access the opioid-reversal drug without having obtained a previous prescription. MassHealth and many insurers covered the drug in this way.
However, in March, the FDA approved an over-the-counter version of the drug, eliminating the need to go to the pharmacy altogether. When it hits store shelves, patients will be able to purchase the opioid reversal drug as easily as Advil or cold medicine.
Advocates were unsure if insurers would cover the over-the-counter versions, and the drug manufacturer has still not released pricing information. Beyond Blue Cross, the response from the insurance community so far has been mixed.
According to the Executive Office of Health and Human Services, MassHealth also plans to cover over-the-counter naloxone without cost sharing. A spokesperson for the office said there will be no limit to the quantity it will cover.
Point32Health, the parent company of Tufts Health Plan and Harvard Pilgrim Health Care, has made prescription naloxone available for all members without cost sharing, but coverage for the newer over-the-counter version will vary.
Medicare members may, depending on plan design, have coverage for an over-the-counter version of the drug, though commercial members will not.
A spokeswoman said the insurer was open to reevaluating its policies, particularly as more information on pricing becomes available, and additional over-the-counter versions come to market. For now, the insurer pointed to the ease of accessing the drug through the pharmacy.
“If the prescription generic naloxone versions become unavailable, we will reassess our coverage options to ensure our members still have access to these potentially lifesaving drugs,” said Kathleen Makela, a spokeswoman for Point32Health.
According to Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, other member plans offer coverage of prescription Narcan, which she noted is available at all Massachusetts pharmacies thanks to the standing order.
“MAHP member plans await further guidance from the state and federal government regarding coverage and availability of over the counter Narcan and will update their coverage policies as guidance is issued to ensure continued member access,” Pellegrini said in a statement.
The Group Insurance Commission, which insures state and some municipal employees, also covers generic naloxone without a cost with a prescription but does not provide coverage for the drug over-the-counter.
Dr. Traci Green, professor and director of the Opioid Policy Research Collaborative at Brandeis University, said she hoped Blue Cross’s announcement would inspire other health plans to follow in their steps, calling the decision “bold.”
“Over-the-counter naloxone may save lives; no-cost over-the-counter naloxone WILL save lives,” she said.
Other advocates also applauded the decision to provide enhanced coverage of over-the-counter naloxone, saying it would improve access to the drug while reducing the stigma of carrying and using it.
“Ending the overdose crisis requires the implementation of evidence-based approaches,” said Julie Burns, president and CEO of RIZE Massachusetts, a nonprofit working to end the state’s opioid epidemic. “And the evidence is overwhelmingly clear that Narcan saves lives. It’s one of the strongest tools we have in our toolbox, and it’s vitally important it be made available everywhere. The decision by BCBSMA to make it available at no cost will help do just that - broaden access across the board.”
Ben Spooner, assistant director for the Center for Strategic Prevention Support, which provides technical assistance and resources to Massachusetts communities to prevent and reduce misuse of drugs and alcohol, called Blue Cross and MassHealth’s coverage decisions “wonderful.”
But he said more can be done to improve education around naloxone, including proactively providing naloxone to patients picking up a prescription for an opioid. Even as the drug moves to over-the-counter use, and away from a transaction with a pharmacist, he hoped people would still receive education on how to use it.
Still, Rich MacKinnon, president of Professional Fire Fighters of Massachusetts, noted that it isn’t uncommon for family members and caretakers to have administered naloxone before first responders even arrive, saying the increased availability of the drug had saved lives. He stressed that even with increased access to the drug, people should still call 911 if a person is found unresponsive.
“You can relate it to the “HEARTSafe communities,” MacKinnon said, referring to a program that promotes CPR instruction, public-access defibrillators, and other initiatives that help reduce deaths from out-of-hospital cardiac arrests. “There was a greater outcome with [cardiac arrest] patients if we had defibrillators around that were easily accessible. And that has saved lives. Narcan is the same avenue … It’s been an education and exposure thing. If that’s the way we’re headed with Narcan, I think it would be successful in saving lives.”