OIG Recommends CMS Make It Easier for Medicaid Beneficiaries to Get Naloxone

The Office of Inspector General (OIG) says Medicaid beneficiaries deserve better access to naloxone, a medication that rapidly reverses opioid overdoses. In a new report, OIG called on the Centers for Medicare & Medicaid Services (CMS) to implement changes to help make it happen. 

An OIG study of state-reported Medicaid data and manufacturer-reported sales data prompted the recommendation.

Findings show that, while Medicaid covers nearly 40% of all nonelderly adults with opioid use disorder (OUD), the joint federal and state program paid for only 5% of all naloxone distributed in the U.S. in 2018.


OIG called that figure “especially concerning” considering the high number of Medicaid beneficiaries with OUD and the fact that “some States with extremely high overdose mortality rates paid for relatively little naloxone under Medicaid.”

As such, OIG is recommending CMS pursue strategies to make it easier for beneficiaries to get community-use versions of naloxone through Medicaid. It went on to suggest some potential actions CMS could take to increase access to the life-saving drug.

Some of those strategies include educating current and potential Medicaid beneficiaries about the availability of naloxone through Medicaid; encouraging and supporting state efforts to make it easier for friends and family members of beneficiaries to obtain the medication through Medicaid; and recommending that states require providers to co-prescribe naloxone alongside prescription opioids.


While it’s unclear if and when CMS will implement any of those actions, it seems to be on board with the sentiment of OIG’s recommendations.

“CMS did not explicitly concur with our recommendation but stated that it is already pursuing multiple strategies to increase the number of at-risk beneficiaries acquiring naloxone through Medicaid and will continue to do so,” the OIG wrote in its report.