Does Medicare Cover Narcan? 

According to the Centers for Disease Control and Prevention, more than 100,000 people died from drug overdoses in the United States last year. Drug overdoses can also be the result of  prescribed medications. For instance, opioid drugs prescribed to relieve pain have the potential to become habit-forming and addictive. In the case of opioid overdoses, using Narcan can reverse the effects and save the patient’s life. 

Opioid pain medications can lead to addiction and overdose

Many people, including seniors, don’t even realize that they have developed an addiction to opioid medications. These medications are often prescribed for legitimate medical purposes. Over time and with repeated use, a person may build up a tolerance to these medications, requiring more and more to be consumed in order to get the same effect.

In doing this, addiction can develop, and before long, some people find that they can’t stop taking these medications without medical help. Addiction can lead to ongoing health concerns and even overdose.

What are the signs of opioid overdose?

Signs and symptoms of an opioid overdose may include:

• Lethargy
• Confusion
• Loss of motor function
• Depression of the central nervous system
• Loss of consciousness

If you or someone you know is experiencing a overdose, it’s vital to seek medical help right away. Medications like Narcan (naloxone HCI spray) have the potential to reverse the effects of opioid medications and help someone who is in the middle of an overdose incident to recover quickly.

Narcan is available as a spray that is administered intranasally. People who live with individuals who are susceptible to opioid overdose are often encouraged to keep Narcan on hand in the event that an overdose takes place.

Does Medicare cover Narcan?

Medicare covers prescription drugs through Medicare Part D, and the program often covers Narcan when a doctor prescribes it for a medically necessary purpose. Medicare Part D plans each come with a formulary or list of covered medications. You will want to consult your plan’s formulary to learn whether Narcan is covered by your Part D plan.

The cost of Narcan under Medicare insurance

If your Medicare benefits cover Narcan under Part D, a copay may be involved at the time of purchase. All medications covered by Medicare Part D must be purchased from a retail pharmacy. Your plan can provide more details about copays for specific medications.

Medicare Part D is optional prescription drug coverage, and carrying Part D requires a monthly premium and annual deductible. The premium cost for Part D coverage can vary from plan to plan, and Medicare recipients with higher incomes may pay more for Part D coverage. The top range for deductible costs for Part D coverage in 2024 is $545, but some plans have no deductible for drugs on certain tiers of coverage.

Narcan coverage when administered by a medical provider

If Narcan is administered as part of medical treatment for an overdose incident, Medicare coverage varies based on how and where the medication is administrated. In an inpatient setting, such as a Medicare-participating hospital or treatment facility, Narcan administration is covered by Medicare Part A. This is the inpatient benefit of Medicare coverage, and it covers the cost of medications and treatments provided while admitted to an inpatient facility.

If Narcan is administered in an outpatient setting or through emergency medical response (EMS) services, Medicare Part B provides coverage. Medicare Part B covers things like ambulance services, clinical care, surgery and durable medical equipment. Because Narcan is usually an emergency response medication, it is often used by first responders and ambulance workers responding to calls about overdose incidents.