NH pays for tiny fraction of Narcan with Medicaid, could be getting a better deal, inspector general's report says

Sep. 24--New Hampshire could get a better deal on Narcan and other drugs used to treat opioid overdoses if the state bought them using Medicaid, according to a report released this week by the Office of the Inspector General for the U.S. Department of Health and Human Services.

New Hampshire's Medicaid program pays for Narcan and other forms of naloxone about half as often as other states. Out of thousands of doses of Narcan and other forms of naloxone administered in New Hampshire in 2018, 575 were paid for by Medicaid, according to the Inspector General's Office -- about 306 per 100,000 Medicaid beneficiaries.

Among states hit hard by the opioid epidemic, that's very low, the report stated.

Bahar Adili, team leader in the Inspector General's Office of Evaluations and Inspections, said this matters because Medicaid could be getting a better deal on Narcan than other programs, including cities, the state, and local police and fire departments.

Because of special rebates only available to Medicaid, the health insurance program for low-income people run jointly by the states and the federal government, Narcan and other forms of naloxone are cheapest when Medicaid buys them.

"What this could mean is distributing naloxone through Medicaid rather than through other channels is the most cost-effective way to get naloxone into more hands," which frees up public money for other uses, Adili said.

Using Medicaid to buy more naloxone could also help get it into the hands of more people who need it, she said.

"Medicaid plays a really key role in all of this because the program serves almost 40% of non-elderly adults in the U.S. who suffer from opioid use disorder," Adili said. "The proportion is fairly small given that the program serves so many people in need."

The report recommends more education for Medicaid patients about getting Narcan, making Narcan and naloxone available to friends and family of people who are on Medicaid -- which Adili noted some states already do -- and encouraging doctors to provide naloxone to patients when they prescribe opioids.

Given how rarely Medicaid pays for Narcan and how many people with substance-use disorders get their insurance through Medicaid, Adili said it was possible that people who need Narcan are having trouble accessing it.

"We really do have a concern that people who need naloxone may not be getting it," she said.

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