Assemblymember Liz Ortega’s bill would require insurers to cover over-the-counter naloxone

Federal regulators are considering allowing consumers to buy naloxone without a doctor’s prescription, and Assemblymember Liz Ortega wants to ensure Californians can afford to purchase the opioid-overdose-reversal medicine if they do.

Ortega (D-Hayward) announced Tuesday that she will be introducing a bill into the state Assembly that would require Medi-Cal and private insurers to cover the cost of naloxone if the U.S. Food and Drug Administration approves over-the-counter sales of either of two nasal sprays — Narcan by Emergent BioSolutions Inc. and RiVive by Harm Reduction Therapeutics Inc.

“As a mom, I think about the danger of fentanyl to my kids every day,” Ortega said in a statement. “It only takes 2 milligrams―smaller than a grain of rice―to end a life. Naloxone saves lives―but only if you can afford it. I’m introducing this bill so that every parent, family member, or guardian can have access to this life-saving drug and protect their kids.”

Joe Greaves, executive director of the Alameda-Contra Costa Medical Association, said in a statement to the East Bay Echo that the association cannot comment on Assembly Bill 1060, which Ortega is set to introduce, just yet “because the bill is not yet in print.” However, he said that the physicians in the community broadly “support efforts to expand safe access to naloxone” given the prevalence of opioid-related overdoses in the community.

“We appreciate Assemblymember Ortega’s efforts and leadership to bring attention to this important issue,” Greaves said, “and we applaud her resolve to expand access to this lifesaving medication.”

While overdose deaths related to heroin have gone down and overdose deaths related to prescription opioids have leveled off, the rise of more potent synthetic opioids, primarily fentanyl, drove a nearly 7½-fold national increase in opioid-related overdose deaths between 2015 and 2021. Of the 107,000 people who died from a drug overdose in the U.S. in 2021, more than 71,000 died from a fentanyl overdose. In California, there were almost 7,000 deaths related to opioid overdose and just under 6,000 were related to fentanyl, according to 2021 data from the state Public Health Department.

Naloxone can counter the effects of an opioid overdose if it is given within a few minutes of a person showing signs of an overdose, such as shallow breathing, unconsciousness and blue lips, among other symptoms. The FDA has been ramping up its efforts to increase access to “overdose reversal products such as naloxone” since 2022. Last week, one of the FDA’s advisory committees unanimously recommended the approval of Narcan for over-the-counter use, with the committee set to review RiVive in about a month.

The biggest question with the FDA decision is what’s going to happen to the price of naloxone, Dr. Lewis Nelson, a professor and chair at the Rutgers New Jersey Medical School, told the East Bay Echo. Insurance companies don’t typically cover over-the-counter medications, especially those that are going to be used on someone else, so ideally it would be made available at a cost of around $1.99 rather than $99.99 to increase public accessibility.

“They have to make it over-the-counter and either require insurance to cover over-the-counter medications, no questions asked for people who might be giving it to other people,” Nelson said, “or they have to lower the price enough so that everybody can afford it.”

The presence of naloxone needs to be as ubiquitous as the presence of defibrillators for cardiac arrest in order to be truly successful because it needs to be administered right away by somebody else, he said.

“You can’t say, ‘Hold on, I’ll be back in 10 minutes. I’m going to run to the pharmacy and pick up some naloxone,'” Nelson said. “It has to be in your backpack or your purse or your glove compartment or your pocket.”

Nelson added that naloxone is not a silver bullet. It does not prevent an overdose from happening in the first place, the way true harm reduction strategies like safe injection sites or fentanyl testing strips can, though it does prevent death. It isn’t the only way to prevent an overdose death either; mouth-to-mouth resuscitation works, too, Nelson said.

“There’s only one reason you die from an opioid overdose,” Nelson said, “and that is respiratory depression, which means your breathing slows or stops. So if everybody learned how to do rescue breathing and if everybody was willing to do it on people they encountered who had an opioid overdose, then we wouldn’t need naloxone.”

But the likelihood the average person would be willing to do mouth-to-mouth resuscitation on a stranger is low, so it isn’t an effective public health intervention, he said. Either intervention may really just be delaying, rather than preventing, death since individuals who had their overdoses reversed may still die from overdose if they don’t get treatment, Nelson said.

“We have good treatments for opioid-use disorder,” Nelson said, “but it’s not simple.”

Addiction is a complicated issue and there is no single cure, Nelson said, but making naloxone easily available and cheap or free “would be a huge step in preventing overdose deaths.”