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Medicaid Behavioral Health Services: Naloxone Nasal Spray Atomizer Covered Without Prior Authorization
This data is presented as an interactive tool that allows users to: filter by timeframe/year, select specific data columns (distributions), filter by state or geography, and view the data as a table, map, or trend chart.
2022
Location
Service Covered?
Copayment Required?
Limits on Services?
United States
Yes - 34; No - 11; NR - 6
Yes - 8
Yes - 2
Alabama
No
Alaska
Yes
NR
NR
Arizona
No
Arkansas
NR
NR
NR
California
No
Colorado
No
Connecticut
Yes
No
No
Delaware
NR
NR
NR
District of Columbia
Yes
No
No
Florida
No
Georgia
NR
NR
NR
Hawaii
Yes
No
No
Idaho
Yes
No
NR
Illinois
Yes
NR
NR
Indiana
Yes
No
NR
Iowa
Yes
No
No
Kansas
Yes
No
No
Kentucky
Yes
No
NR
Louisiana
No
Maine
Yes
$3 per prescription, up to $30 per month
No
Maryland
Yes
$1 for generic and $3 for brand name, If the drug is administered as a part of a larger visit, there's no cost sharing
NR
Massachusetts
Yes
No
No
Michigan
Yes
No
No
Minnesota
NR
NR
NR
Mississippi
Yes
$3
No
Missouri
Yes
Yes - not specified
No
Montana
Yes
No
No
Nebraska
No
Nevada
Yes
No
NR
New Hampshire
NR
NR
NR
New Jersey
Yes
No
No
New Mexico
Yes
No
No
New York
Yes
No
No
North Carolina
Yes
$4
NR
North Dakota
Yes
No
No
Ohio
Yes
No
Prior authorization is not required when medication is dispensed or administered in a behavioral health or other medical setting.
Oklahoma
No
Oregon
Yes
No
No
Pennsylvania
Yes
No
No
Rhode Island
Yes
No
No
South Carolina
Yes
No
NR
South Dakota
Yes
$1 pharmacy copay for generic and $3.30 for brand-name
No
Tennessee
No
Texas
No
Utah
NR
NR
NR
Vermont
Yes
$1, $2 or $3, depending on the cost of the drug
NR
Virginia
Yes
No
No
Washington
Yes
No
No
West Virginia
Yes
No
Based on medical necessity
Wisconsin
No
Wyoming
Yes
$0.65 generic, $3.65 brand
No
2018
Location
Service Covered?
Copayment Required?
Limits on Services?
United States
Yes - 25 No - 19 NR - 7
Yes - 13
Yes - 8
Alabama
No
Alaska
No
Arizona
No
Arkansas
Yes
N/A
Quantity limit per claim
California
No
Colorado
Yes
$3 per prescription or refill
Each drug may be subject to utilization controls per the Preferred Drug List or Appendix P criteria.
Connecticut
No
Delaware
Yes
No
Prior approval not needed for once a day dosage
District of Columbia
Yes
$1.00/Rx for point of sale drugs only
No
Florida
No
Georgia
No
Hawaii
Yes
No
No
Idaho
Yes
No
NR
Illinois
NR
NR
NR
Indiana
Yes
$3 per prescription
No
Iowa
NR
NR
NR
Kansas
Yes
$3.00 per prescription
No
Kentucky
Yes
Generic prescription drug $1 Preferred brand name drug $4
1 package (2 units) per rolling 30 days
Louisiana
No
Maine
No
Maryland
Yes
$1 for generic and preferred brand name drugs; $3 for other brand name drugs
NR
Massachusetts
Yes
No
No
Michigan
No
Minnesota
Yes
Minnesota assesses a $3 copay for non-preferred drugs, and $1 copay for preferred drugs. Copays are limited to $12 per month. No copays are assessed for certain mental health drugs.
NR
Mississippi
No
Missouri
Yes
$0.50 - $2 based on ingredient cost
No
Montana
Yes
No
No
Nebraska
No
Nevada
Yes
No
No
New Hampshire
Yes
No
No
New Jersey
Yes
No
No
New Mexico
Yes
No
No
New York
NR
NR
NR
North Carolina
NR
NR
NR
North Dakota
No
Ohio
Yes
No
PA required for Nasal spray atomizer prescriptions written by prescribers other than those employed by agencies certified by Ohio Department of Mental Health and Addiction Services.
Client copay is $0.65 per prescription for generic drugs and $3.65 per prescription
One fill of naloxone product per 365 days is covered without PA; subsequent fills within the 365 day lookback require PA and referral to case management