Over-the-counter opioid overdose antidote Narcan is arriving in stores

By Meg Tirrell and Nadia Kounang

The first over-the-counter naloxone, a drug used to reverse opioid overdose, is starting to come available in retail stores and online.

The medicine, with the brand name Narcan, has a suggested retail price of $44.99 per carton of two doses, maker Emergent BioSolutions said in a news release last week. It will be available initially in stores and online from retailers including Walgreens, Rite Aid, Walmart and CVS.

The US Food and Drug Administration approved Narcan as an over-the-counter drug in March against a backdrop of record high deaths from opioid overdose, driven by powerful synthetic drugs like fentanyl. Narcan is a nasal spray version of naloxone, which can revive a person from an overdose within minutes.

Nearly every state in the US has standing orders that previously allowed pharmacists or other qualified organizations to provide the medication without a personal prescription to people who were at risk of an overdose or were helping someone at risk. The approval now allows the drug to be sold without any sort of prescription.

“We think really everyone should be thinking about putting this into their first aid kit,” Walgreens Chief Medical Officer Dr. Kevin Ban told CNN. “It’s really unlimited in terms of the folks who should make sure that they get some naloxone in the off chance that they come across someone who was experiencing an overdose. This is a way to reverse that overdose. It’ll save people’s lives.”

Advocates for increased access to naloxone cheered the news that the drug will be available without a prescription but said it won’t be a panacea for the overdose crisis, both because it’s too pricey and because pharmacies aren’t how most people who need naloxone get it.

“It is excellent news that there’s an over-the-counter naloxone product,” said Maya Doe-Simkins, co-director of Remedy Alliance/For the People, which aims to increase access to affordable naloxone.

But, she added, naloxone is distributed primarily through bulk purchases by organizations or governments, which then make it available directly to people who use drugs.

“This is the evidence-based model that is proven to save lives,” she said.

As part of its announcement last week, Emergent BioSolutions also said it was lowering Narcan’s so-called public interest price for community groups, first responders, state and local governments and harm reduction groups to $41 per two-dose carton starting Thursday. The company declined to say what the previous price was but noted that it was $75 when it acquired the product in 2018 and has been lowered over time.

The FDA approved another nasal spray naloxone, called RiVive, in July. Its manufacturer, the nonprofit Harm Reduction Therapeutics, says it will sell at cost starting in early 2024: $36 per two-pack.

Versions of naloxone given by injection are much cheaper and still available by prescription.

Because of the price, some retailers are implementing theft protection for Narcan. Rather than using locked cases, which could contribute to stigma, Walgreens says it will offer customers cards for naloxone on shelves that they can then take to a register or pharmacy to purchase the drug.

“That allows there to be sort of easy requests without having to ask for it,” Ban said. “That’s one of the things we wanted to remove. We realized that a lot of people just don’t want to ask for the medication. So we came up with that mechanism to grab this card, then you can either bring it to the front of the store or the back of the store.”

Rite Aid said the product would be available in its stores in the pain care aisle. Walmart said Narcan would be available in the over-the-counter medication aisle in all stores, although it didn’t immediately respond to a question about whether it would have any theft prevention measures.

CVS told CNN that Narcan will be available at the pharmacy counter so its teams could check for potential savings for prescription naloxone products through insurance. It said Narcan would also be available at the register in the front of the store, as well as through pickup or delivery for customers seeking more privacy.

Doe-Simkins noted that any additional steps to accessing naloxone may still deter some people from wanting to buy it.

“Anything that’s layered on to naloxone access is a barrier,” she said. Still, she said its availability over-the-counter is something the community has been waiting for.

“We’ve been advocating for that for well over a decade,” Doe-Simkins noted. “It’s about time.”