Data Watch: Naloxone Prescription in Response to the Opioid Epidemic

In response to the opioid epidemic, policies to expand access to the overdose-reversal drug naloxone have emerged across the country. In Arkansas, Act 651 of 2021, which went into effect on July 28, 2021, requires a co-prescription of naloxone in certain situations, including when a dosage for an opioid prescription is 50 or more morphine milligram equivalents (MME) per day. In 2017, licensed pharmacists became authorized to dispense naloxone to individuals without a prescription under a state protocol.

Since 2020, ACHI has conducted annual analyses of naloxone and opioid prescriptions for Medicaid and commercially insured enrollees. Data for the analyses are from the Arkansas All-Payer Claims Database, part of the Arkansas Healthcare Transparency Initiative, for state fiscal years (FY) 2017 to 2023. The results of our analyses are contained in an updated installment of our Data Watch series.

Key findings:

• From FY 2022 to FY 2023, there was a 2.2% increase in naloxone prescription fills and a 2.2% increase in enrollees who filled a naloxone prescription.
• The number of enrollees who filled opioid prescriptions decreased overall from FY 2018 to FY 2023, while the number of enrollees who filled naloxone prescriptions increased.
  • Among enrollees who filled opioid prescriptions of 50 or more MME per day, the rate of fills from naloxone co-prescribing increased from 0.06% in FY 2017 to 16.17% in FY 2023.
  • Among enrollees who filled opioid prescriptions of 90 or more MME per day, the rate of fills from naloxone co-prescribing increased from 0.13% in FY 2017 to 21.82% in FY 2023.
• The ratio of naloxone prescription fills to the number of enrollees receiving high-dose opioid prescriptions remained stable from FY 2022 to FY 2023.
  • In FY 2023, one naloxone prescription was filled for every six enrollees with opioid prescriptions of 50 or more MME per day, the same ratio seen in FY 2022.
  • In FY 2023, one naloxone prescription was filled for every five enrollees with opioid prescriptions of 90 or more MME per day, a decrease from one naloxone prescription fill per four enrollees in FY 2022.
• In FY 2023, 3,807 out of 26,613 naloxone prescription fills, or 14.3%, were initiated by pharmacists.