Over-the-Counter Isn’t the Same as Accessible

On a routine trip to CVS to pick up my brother’s EpiPen, I absentmindedly browsed the shelves while waiting at the pharmacy. Amid the usual cold and flu remedies, one item stopped me in my tracks: Narcan nasal spray, two doses for $44.99. That’s $22.50 per dose, which is more than double the average minimum hourly wage in this country. I was stunned. How can a life-saving medication, one that can reverse a fatal overdose in seconds, come with such a steep price tag? For something that can mean the difference between life and death, how is this cost even remotely defensible?

 

Narcan, the brand name for naloxone, is a medication that can quickly reverse opioid overdoses. In late 2023, the FDA approved Narcan as an over-the-counter drug, seemingly a step towards accessibility. However, the reality is far grimmer.

 

Previously, Narcan required a prescription, which allowed people with insurance to pay a copay of up to $30, yet it was still a high barrier for many. Without insurance, this medication would cost an individual a hefty $130.  Now that Narcan is an over-the-counter medication, it no longer qualifies for insurance coverage. This leaves many individuals to bear the full cost of an almost $50 price tag in exchange for a product that costs a few cents to manufacture. 

 

According to internal FDA data, raw naloxone materials cost around $0.01 to $0.02 per milligram of raw naloxone materials and up to 5 cents to fully manufacture Narcan nasal sprays. So why are consumers being charged over 1000 times the production cost?

 

In the fourth quarter of 2023, from October to December, when the FDA approved Narcan for over-the-counter use, Emergent Biosolutions, the company behind Narcan, reported a total revenue of $276 million. Specifically, Narcan nasal spray alone generated $111 million in revenue during Q4 of 2023. When comparing the few cents of manufacturing to the millions of dollars Emergent Biosolutions is raking in, the cost for consumers is simply unjustifiable.

 

In the midst of a continuing opioid crisis that kills over 100,000 Americans every year, Narcan is an essential public health tool. Although injectable naloxone exists, Narcan’s nasal spray is incredibly user-friendly and requires no medical training, allowing almost anyone to easily administer this drug. 

 

While some community programs distribute Narcan for free, these programs aren’t always consistent or easily accessible. Making Narcan over-the-counter hasn’t done enough to improve accessibility, but instead, it has increased the financial burden on the people who need it the most. 

 

More and more lives will continue to be lost because of the profit margins for big companies like Emergent Biosolutions. If we are fully committed to ending the opioid epidemic, we must demand that Narcan be significantly more affordable, if not free, for all.