Medicare and Medicaid enrollees generally had opioid reversal medication coverage

According to the Government Accountability Office, all Medicare Part D enrollees had coverage for some form of naloxone in 2025, and all Medicaid enrollees had such coverage in 2024. Coverage for nalmefene was less common in both programs.

The report was published Monday 09 November 2026. GAO analyzed federal data to assess medication coverage and out-of-pocket costs for enrollees of Medicare Part D and Medicaid.

GAO identified naloxone and nalmefene as the two types of opioid overdose reversal medications. Both are available as injections and nasal sprays in generic and brand versions. Naloxone is also available in low and high doses, including low-dose nasal sprays for over-the-counter use since 2023.

Medicare Part D out-of-pocket costs varied by formulation and by brand or generic status. Generic naloxone injections had the lowest costs, with a $3 to $10 median copay. The highest costs were a 25 to 35 percent median coinsurance for brand high-dose naloxone and nalmefene nasal sprays.

For a covered nasal spray costing $150, enrollees would pay about $38 or $53, depending on whether their coinsurance rate was 25 percent or 35 percent. Medicaid enrollees in two of four selected states had no copays, while enrollees in the other two states had copays below $5.

GAO analyzed Centers for Medicare & Medicaid Services’ Part D data for 2025 and Medicaid drug reimbursement data for all 50 states and the District of Columbia for 2024. It also analyzed Part D coverage and Medicaid utilization.

GAO identified states as having Medicaid coverage when there was utilization of opioid overdose reversal medications. Other states may have coverage but no utilization. GAO also interviewed representatives from a nongeneralizable selection of four Part D plan sponsors and four state Medicaid programs. The sponsors ranked among the top eight by national market share, and the states varied in overdose rates and geography.