The first week of September has seen major pharmacy chains across the United States roll out the nation’s first over-the-counter (OTC) naloxone product, following Food and Drug Administration approval in March. CVS, Walgreens, Walmart and Rite Aid now carry OTC Narcan online and at a limited number of storefronts. All are selling the two-pack nasal sprays for around $44.99, the price suggested by manufacturer Emergent BioSolutions.
Over the past year, the FDA has in stages removed all major regulatory barriers to public naloxone access, culminating with approving the first nonprescription version of the overdose antidote. Though Emergent’s 4 mg Narcan spray is the first product to be FDA-designated as OTC, a patchwork of state-level laws had already allowed pharmacies in all US jurisdictions to sell Narcan without a prescription for years.
The FDA’s approval of a nonprescription product was widely touted in the media as a watershed moment for naloxone access, but very few people who use Narcan buy it from pharmacies. The real impact of OTC Narcan becoming commercially available at pharmacies is that it’s also on its way to retailers that are not pharmacies—and that it’s the necessary first step before additional OTC naloxone products can arrive to drive down the price.
Emergent’s suggested price of $44.99 is preferable to $150, but it’s still $44.99 more than it needs to be.
Following its approval of Emergent’s product in March, the FDA stated that OTC status paved the way for naloxone “to be sold directly to consumers in places like drug stores, convenience stores, grocery stores and gas stations, as well as online.” Emergent has begun shipping inventory accordingly.
Kroger, the nation’s largest grocery chain, is expected to begin selling OTC Narcan in early September, but had not made it available online at publication time. Over time, more smaller businesses will be able to stock it as well—if cost isn’t a barrier.
Emergent’s suggested price of $44.99 is preferable to the previous prescription-status price of $150, but it’s still $44.99 more than what it needs to be in order to be accessible to low-income people who use drugs, who are the first responders to the vast majority of overdoses.
Authorized syringe service programs (SSP) use government funding to purchase naloxone at the public interest price of around $75 for a two-pack and then distribute it to drug users for free. But many jurisdictions without SSP are effectively naloxone deserts, and these are often the same places that don’t have big-box pharmacy chains. People in these communities will continue to rely on free naloxone-by-mail distributors like NEXT Distro, or on Remedy Alliance/For The People, which supplies generic intramuscular naloxone in bulk.
In July, after a winding journey through through the FDA, a nasal spray device from nonprofit Harm Reduction Therapeutics (HRT) became the second naloxone product approved as OTC. ReVive, a 3 mg spray, is expected to be commercially available in early 2024. HRT has stated that “no company, entity or individual will profit from sales of RiVive™,” and implied the retail cost will be under $36.
Emergent, meanwhile, continues to capitalize on needle stigma to market its product as more appealing than intramuscular naloxone, which is significantly more affordable and often more humane compared to the nasal sprays.
“Easy to use,” states Emergent’s OTC Narcan fact sheet. “No swabs or injections needed.”
Image of Emergent BioSolutions Narcan product courtesy of Walgreens
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