Over-the-counter Narcan expected to arrive in stores: Cost, how it works, where to buy

Over-the-counter Narcan nasal spray is expected to show up in local stores this week, the latest attempt to quell the nation's drug overdose crisis — which killed an estimated 109,000 lives last year ― by making the opioid overdose reversal drug more available to the public.

Here's what you need to know:

What does Narcan do exactly?

Narcan (generic: naloxone) reverses opioid overdoses. Opioids include prescription drugs such as OxyContin, Percocet, Vicodin and hydromorphone. They also include the street drugs heroin and fentanyl. Illicit fentayl is responsible for the majority of drug overdose deaths in the United States.

It works relatively quickly, usually within 2 or 3 minutes, though sometimes one dose is not enough.

Its effects last for between 30 and 90 minutes.

When do you use Narcan?

Any time you believe someone is overdosing.

Signs of overdose include: loss of consciousness; slow, shallow or no breathing; loud snoring or gurgling; pinpoint pupils; inability to speak; a limp body; pale complexion; lips or fingernails that are turning purple.

Even if you think they're overdosing on a non-opioid, always use Narcan. Why? Because unbeknownst to users, fentanyl is often cut into non-opioid street drugs including cocaine and counterfeit Xanax. Giving Narcan to someone who is overdosing on something other than an opioid is not harmful to them.

How much does Narcan cost?

The manufacturer's suggested retail price for a package containing two 4 mg doses of the over-the-counter Narcan nasal spray is $44.99. Despite the suggested retail price, the manufacturer, Emergent BioSolutions, points out that individual retailers set the price. Which means it could cost more or it could cost less with store promotions.

Some who work in drug treatment and harm reduciton have argued that while it's nice Narcan is available, the price is too steep for many people — especially since drugs have gotten more potent with the addition of fentanyl and it's sometimes necessary to use more than one dose of Narcan to bring someone back.

Previously, it could cost upwards of $140 without insurance or a coupon.

Over-the-counter naloxone made by other companies is poised to enter the retail market, too. It's possible prices will come down as competition heats up.

Can you use your FSA or HSA on over-the-counter Narcan?

Yes.

Does insurance cover over-the-counter Narcan?

For that, you'll need to check with your insurance company. Generally speaking, insurance does not cover over-the-counter medications but some companies may make exceptions.

At Blue Cross Blue Shield of Michigan, prescription-only Narcan and its generic equivalents are covered with a co-pay that is determined by an insured person's specific benefit plan, the insurer said in a statement. But, BCBSM added that could change. "We are in the process of reassessing all available Narcan products in the marketplace, including over-the-counter products, for possible coverage updates."

Do Medicaid and Medicare cover over-the-counter Narcan?

Yes, but it's a little complicated.

According to the Michigan Department of Health and Human Services:

Medicaid covers over-the-counter Narcan but federal rules require prescriptions in order for over-the-counter medications to be covered. So, you'll need to get a prescription for your Narcan. Through Michigan's standing order regarding Narcan, your pharmacist can provide you with one. Once you have a prescription, your over-the-counter Narcan will be free of charge.

The Medicare Part D (drug) benefit noes not cover over-the-counter medications.

Can you buy Narcan online?

Yes. Pharmacies that offer Narcan for online purhase include: riteaid.com, cvs.com, walgreens.com, walmart.com.

In which states can you get Narcan over the counter?

The U.S. Food and Drug Administration has given approval for Narcan to be sold over-the-counter in all 50 states and the District of Columbia and Puerto Rico. But that doesn't mean all pharmacies will carry it. Right now, you're most likely to find it in national pharmacy chains.

More: Narcan approved for over-the-counter sales: What it means for Michigan

More: Narcan 101: How to use it, why it works and how to get it

Why is Narcan just now available in pharmacies?

Even though it was a prescription drug, it's been available at participating Michigan pharmacies without a prescription since 2017 through a standing order passed by the Michigan Legislature. About 60% of the state's pharmacies carried Narcan under that order.

Giving Narcan over-the-counter status by the FDA is an attempt to expand its availability across the nation so that every state is on equal regulatory footing when it comes to Narcan. Also, having it easily available in stores just like aspirin or Tylenol may reduce the stigma associated with Narcan.

Who should carry Narcan?

Drug users or anyone who knows a drug user, members of the general public who are concerned about drug overdoses and want to be able to help if they encounter someone overdosing.

How can you get free Narcan?

Community organizations and harm reduction groups provide free Narcan. Vending machines that dispense Narcan for free are located in some libraries and public facilities. To find free Narcan, click here.

This article originally appeared on Detroit Free Press: Over-the-counter Narcan spray: Cost, free options, where to buy