Press Releases

WASHINGTON – Last week, Rep. Lisa Blunt Rochester (D-Del.), member of the House Health Subcommittee, joined Reps. Frank Pallone, Jr. (D-N.J.), Annie Kuster (D-N.H.), and Angie Craig (D-Minn.) in sending a letter to the U.S. Government Accountability Office Comptroller General urging action be taken on a study on the accessibility and affordability of FDA-approved opioid overdose reversal agents, including naloxone and nalmefene.

In Delaware, Kent and Sussex counties have faced a spike in overdose deaths in recent weeks underscoring a clear and immediate need for additional resources to help combat the opioid epidemic. Blunt Rochester has long advocated for increasing the affordability and accessibility of naloxone, having introduced H.R. 4005, the Naloxone Affordability Act alongside Kuster and Craig in June 2023. This legislation would ensure access to naloxone for communities nationwide to help end addiction and combat the mental health crisis. Blunt Rochester also introduced the bipartisan STOP Fentanyl Overdoses Act with Kuster and Rep. Don Bacon (R-NE) in May 2023 to address fentanyl as a primary contributor to the increase in overdoses nationwide. Additionally, Blunt Rochester has secured federal funding through the House’s Community Project Funding process to increase access to mental health support and strengthen the mental health care workforce. 

The full letter is below and here.

May 16, 2024

 

The Honorable Gene Dodaro Comptroller General

U.S. Government Accountability Office 441 G St. NW

Washington, DC 20548

 

Dear Comptroller General Dodaro:

We write today to request the Government Accountability Office (GAO) conduct a study on the accessibility and affordability of U.S. Food and Drug Administration (FDA)-approved opioid overdose reversal agents, including naloxone and nalmefene.

Overdose reversal medications are safe and effective life-saving tools that can reduce overdose deaths. To date, FDA has approved two opioid overdose reversal agents. As a harm reduction tool, overdose reversal medications play a critical role in a science-based approach to the drug overdose crisis. Despite access to these medications over-the-counter (OTC), we remain concerned that several barriers continue to hinder its widespread uptake and access.

These barriers include, but are not limited to, out-of-pocket costs for patients, pharmacy stocking decisions, awareness of drug availability in pharmacies, and unclear insurer reimbursement policies.

Currently, insurance coverage for OTC opioid overdose reversal medications varies across insurers and states. If people are unaware that insurance might cover OTC costs or that standing orders exist, they may avoid purchasing these life-saving medications altogether to avoid out-of-pocket expenses.

As opioid deaths continue to mount, it is imperative we understand these barriers to ensure individuals at high-risk and their social networks have access to life-saving reversal medication. We request that the GAO analyze federal health insurance plans, to the extent data are available, including traditional Medicare and Medicare Advantage, Medicaid and Medicaid managed care, and private group and individual health plans, with a focus on the following questions:

1. How are opioid overdose reversal agents currently covered by selected federal and private health plans?
2. Can naloxone be covered as an over-the-counter drug for individuals –
   1. Under a group or individual health insurance plan?
   2. Entitled to benefits under Part A or enrolled under Part B of Medicare?
   3. Receiving medical assistance under a State Medicaid plan?
3. What is known about the out-of-pocket cost to consumer purchasing naloxone –
   1. With a prescription, with and without any health plan coverage?
   2. Over-the-counter, with and without any health plan coverage?
   3. Pursuant to a standing order?
4. What information is known about other factors impacting coverage, including –
   1. Barriers in covering naloxone as an over-the-counter drug?
   2. The availability of naloxone purchased and distributed through public health entities?

By focusing on these core questions, we believe the GAO can provide Congress with important details on the accessibility and affordability of opioid reversal agents to inform future laws and regulations.

Thank you for your attention to this matter. Please have your staff work with Shana Beavin of the Energy and Commerce Committee’s Democratic staff and Tara Jordan with the office of Congresswoman Kuster on the scope and details of your work. We trust that you will prioritize this study and eagerly await your response.

Sincerely,

Lisa Blunt Rochester

Member of Congress

 

Frank Pallone, Jr.

Member of Congress

 

Annie M. Kuster

Member of Congress

Angie Craig

Member of Congress

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