Context. Just prior to naloxone going OTC, we wanted to document how much naloxone nasal spray (Narcan) cost out of pocket at community pharmacies in NC. So we did a phone-based secret shopper study, of 202 community pharmacies recently published. (email us if you need the PDF) This work was led by Delesha Carpenter and team at UNC Eshelman School of Pharmacy.
By the Numbers. Only 53% of pharmacies were willing to dispense naloxone without a prescription using NC standing orders. Chain pharmacies (64%) were more likely than independent pharmacies (35%) to use the standing order.
Go Deeper. The average cost for Narcan was approximately $96 (mean: $96.27; standard deviation [SD]: $38.16, median: $90). The average cost of naloxone at chain pharmacies (mean = $84.69; SD 34.9, median: $76.22) was significantly lower than independent pharmacies (mean = $113.54; SD: 36.54, median: $104.98).
Between the Lines. Naloxone availability was not significantly different by rurality (χ2 = 1.77, df = 4, P value = 0.78).
Yes, But. Now that some naloxone nasal sprays are OTC, the price we've seen on the shelves is around $50, but we will systematically measure that in the fall to see what effect OTC status has on price.
Go Deeper. Other results from the study provide more detail, below.
All health department pharmacies that reported they would dispense naloxone also said they would dispense naloxone for free. At community pharmacies, the cost ranged from $38.11 to $220.00 for a 2-pack box of 4-mg nasal spray. In 13 of 197 calls, pharmacies indicated that they could not look up the cost of naloxone without an active prescription. The average cost across all calls was approximately $96 (mean: $96.27; standard deviation [SD]: $38.16, median: $90). The average cost of naloxone at chain pharmacies (mean = $84.69; SD 34.9, median: $76.22) was significantly lower than independent pharmacies (mean = $113.54; SD: 36.54, median: $104.98) (t = 4.57, df = 130, P < 0.001). Quoted out-of-pocket cost was not statistically different between pharmacies on and off the standing order participant list (t = −1.731, df = 139, P = 0.97).
Background
According to a standing order in North Carolina (NC), naloxone can be purchased without a provider prescription.
Objective
The objective of this study is to examine whether same-day naloxone accessibility and cost vary by pharmacy type and rurality in NC.
Methods
A cross-sectional telephone audit of 202 NC community pharmacies stratified by pharmacy type and county of origin was conducted in March and April 2023. Trained “secret shoppers” enacted a standardized script and recorded whether naloxone was available and its cost. We examined the relationship between out-of-pocket naloxone cost, pharmacy type, and rurality.
Results
Naloxone could be purchased in 53% of the pharmacies contacted; 26% incorrectly noting that naloxone could be filled only with a provider prescription and 21% did not sell naloxone. Naloxone availability by standing order was statistically different by pharmacy type (chain/independent) (χ2 = 20.58, df = 4, P value < 0.001), with a higher frequency of willingness to dispense according to the standing order by chain pharmacies in comparison to independent pharmacies. The average quoted cost for naloxone nasal spray at chain pharmacies was $84.69; the cost was significantly more ($113.54; P < 0.001) at independent pharmacies. Naloxone cost did not significantly differ by pharmacy rurality (F2,136 = 2.38, P = 0.10).
Conclusion
Approximately half of NC community pharmacies audited dispense naloxone according to the statewide standing order, limiting same-day access to this life-saving medication. Costs were higher at independent pharmacies, which could be due to store-level policies. Future studies should further investigate these cost differences, especially as intranasal naloxone transitions from a prescription only to over-the-counter product.