Medicaid Behavioral Health Services: Naloxone Nasal Spray Covered Without Prior Authorization

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2022

Location	Service Covered?	Copayment Required?	Limits on Services?
United States	Yes - 44; No - 1; NR - 6	Yes - 11	Yes - 8
Alabama	No
Alaska	Yes	NR	NR
Arizona	Yes	$4 for some members	No
Arkansas	NR	NR	NR
California	Yes	No	No
Colorado	Yes	No	Limited to 2 per 30 days; limit can be overridden with a prior authorization
Connecticut	Yes	No	No
Delaware	NR	NR	NR
District of Columbia	Yes	No	No
Florida	Yes	No	Maximum of 4 sprays per year for Narcan spray and for Kloxxado spray
Georgia	NR	NR	NR
Hawaii	Yes	No	No
Idaho	Yes	No	Limit of 3 per day
Illinois	Yes	NR	NR
Indiana	Yes	No	NR
Iowa	Yes	No	No
Kansas	Yes	No	No
Kentucky	Yes	No	NR
Louisiana	Yes	Yes - not specified	Two units per rolling 90 days
Maine	Yes	$3 per prescription, up to $30 per month	Limit of 2 units per 28 days
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	Yes	No	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	No
Oklahoma	Yes	NR	Limit of 2 per 30 days, which can be overridden with a prior authorization
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	Yes	No	No
Texas	Yes	No	No
Utah	NR	NR	NR
Vermont	Yes	$1, $2 or $3, depending on the cost of the drug	Narcan (naloxone hcl) Nasal Spray Quantity Limit = 4 single-use sprays per 28 days
Virginia	Yes	No	No
Washington	Yes	No	No
West Virginia	Yes	No	Based on medical necessity
Wisconsin	Yes	$1 generic, $3 brand for drugs billed under the pharmacy benefit	NR
Wyoming	Yes	$0.65 generic, $3.65 brand	No

2018

Location	Service Covered?	Copayment Required?	Limits on Services?
United States	Yes - 43 No - 3 NR - 5	Yes - 22	Yes - 12
Alabama	Yes	No	NR
Alaska	Yes	No	No
Arizona	Yes	$2.30 per prescription for beneficiaries with Transitional Medical Assistance	No
Arkansas	Yes	$0.50 to $3.00 depending on cost	Quantity limit per claim
California	Yes	No	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	Yes	No	Only Narcan 4mg Nasal Spray (NDC 69547-0353-02
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	Yes	No	Narcan has a Maximum of 2(1Kit) per 365 days
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	Yes	$0.50-$3.00 based on drug cost	Two units per rolling 90 days
Maine	Yes	$3/Rx, up to $30/month	Quantity limits apply 2 units/28 days
Maryland	Yes	$1 for generic and preferred brand name drugs; $3 for other brand name drugs	NR
Massachusetts	Yes	No	No
Michigan	Yes	No	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	Yes	$3 Copay (excludes EPSDT, LTC and pregnant women)	2 Brand/5 prescription per month limit
Missouri	Yes	$0.50 - $2 based on ingredient cost	No
Montana	Yes	No	No
Nebraska	Yes	No	No
Nevada	Yes	No	No
New Hampshire	Yes	zero, $1.00 and $2.00 dependent upon multiple factors: FPL, drug, if waiver recipient and preferred drug status	No
New Jersey	Yes	No	No
New Mexico	Yes	No	No
New York	NR	NR	NR
North Carolina	NR	NR	NR
North Dakota	Yes	$3 per prescription fill for brand names only	No
Ohio	Yes	No	No
Oklahoma	Yes	Yes - Not Specified	NR
Oregon	Yes	No	No
Pennsylvania	Yes	No	No
Rhode Island	Yes	No	No
South Carolina	NR	NR	NR
South Dakota	No
Tennessee	No
Texas	Yes	No	No
Utah	Yes	$4 for each prescription	NR
Vermont	Yes	$1-3 depending on cost	NALOXONE HCL Prefilled luer-lock needleless syringe plus intranasal mucosal atomizing device (Rescue kit) NARCAN® (naloxone hcl) Nasal Spray Quantity Limit = 4 single-use sprays/28 days
Virginia	Yes	$1 for brand, $3 for brand in FFS	No
Washington	Yes	No	No
West Virginia	Yes	Please see above	No
Wisconsin	Yes	Generic status of compounded products: $1.00 Brand status is $3.00 Maximum copayment of $12.00 per member, per provider, per calendar month.	Not covered for SeniorCare members over 200% FPL
Wyoming	Yes	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

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Medicaid Behavioral Health Services: Naloxone Nasal Spray Covered Without Prior Authorization

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Medicaid Behavioral Health Services: Naloxone Nasal Spray Covered Without Prior Authorization

2022

2018

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